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Do Vaccines Cause Autism in Dogs?
#1
Do Vaccines Cause Autism in Dogs?
Posted on April 9, 2017 by skeptvet
Introduction
Before training as a veterinarian, I studied animal behavior. I worked with primates, and one of the most fascinating aspects of these animals was the deep similarity between their behavior and that of humans. Such similarities shouldn’t be surprising, of course, because we share many of the mechanisms that produce our behavior. Evolution has produced brains and sense organs and various anatomical and physiological systems for generating behavior, and many of these systems are shared between species. The more closely related, in evolutionary terms, the species are, the more such behavior-generating mechanisms they share, and the more similar their behavior is likely to be.
This, of course, applies to all species, not just between humans and other primates. It is not difficult to find great behavioral similarity among mammals, even between relatively distantly-related groups such as human and our canine and feline companions. The similarities may be fewer and the differences more noticeable, but we still share much of our basic biology, including the mechanisms that generate behavior, and we exhibit many behaviors that appear similar in form and function.
One major challenge in studying animal behavior is how to choose our terminology. Many of the words describing behavior in humans contain explicit or implicit information about mental states. If I say someone is angry or afraid, I am describing their feelings and internal experience directly, and presuming it conforms to general human patterns. But if I say someone is “cowering from her” or is “pummeling his face,” these descriptions of behavior contain implied mental states, of fear and anger respectively. So when we describe the behavior of animals, how do we handle the explicit or implicit attribution of mental states that we cannot verify are present or the same as those in humans when animals cannot verbalize their feelings and agree on appropriate descriptive terms? Should we avoid assuming mental states like our own, and if we should how do we accomplish this using language that so often contains implicit attribution of such mental states?
There is no simple solution to these questions. We can try to describe all behaviors mechanically, in terms of specific body movements, but that is cumbersome and arguably misses important and obvious attributes of the behavior. A dog and cat may both wag their tails, but the likely response if you persist in doing whatever you did to start the tail wagging is likely to be very different. The dog might well lick your face while the cat might as likely scratch it! Saying that the dog “wagged his tail playfully” and the cat “flicked her tail irritably” implies mental states we cannot absolutely verify, but these descriptions are a lot more useful and predictive of future behavior.
Some people object to at least some use of terms connoting mental states to dogs and cats because we cannot know their feelings with certainty, and because there are obvious cognitive differences between humans and our pets that influence the kinds of mental states we think it likely dogs and cats can have. There is, of course, a matter of degree in this. If we say “the dog is afraid” or “the cat is mad,” some people might object, but most would accept these terms as roughly appropriate. However, if say “the dog is skeptical” or “the cat is devout,” few people would accept those as legitimate because they imply thought processes we think our pets are unlikely to be capable of. There is, not surprisingly, a large grey area between these extremes.
There are pros and cons to using descriptions for feelings and behaviors in our pets that are commonly used to describe such feelings and behaviors in people. On one hand, we risk anthropomorphism, the attribution of human feelings and motivations to non-human animals. For example, people often describe their dog as looking “guilty” when he or she is punished for peeing in the house. It is unlikely, however, dogs, understand the kinds of obligations and social conventions required to feel guilty for violating a promise not to pee in the house. Thinking the dog can have this level of comprehension and the feeling of remorse can often lead owners to imagine intentions, a deliberate desire to defy the owner, that the dog also probably doesn’t have, which can negatively influence their bond with the pet and the way they try to alter the undesirable behavior.
Similarly, when a cat pees in the house while an owner is on a trip, the owner will often say the cat did it “because he was mad at me.” This generates a very different owner response than if we describe the behavior as “inappropriate urination associated with routine change: or something more emotionally neutral.
On the other hand, because humans share evolutionary relationships and many of the basic mechanisms of behavior with other animals, it is perfectly reasonable to assume significant similarity in the genesis of behavior and internal experiences. The presumption that humans are fundamentally, qualitatively different in every way from all other animals in their mental states or behavior is scientifically implausible, as well as being arrogant and self-serving.  Mental similarities that correspond to similarities in behavior are a likely and parsimonious way of studying and characterizing animal behavior.
All of this is by way of introducing the real subject of this post, the question of whether dogs can fairly be described as “autistic” and, if so, whether we can blame this on vaccination
So Can Dogs Get Autism?
This question was recently brought to my attention by some fellow skeptics who pointed me towards a dramatic and inflammatory article on an anti-vaccine web site.
Autism Symptoms in Pets Rise as Vaccination Rates Rise from The Vaccine Reaction Web Site
As the title suggests, this article makes several claims about canine behavioral disorders and vaccines, which I will address individually:

  1. Pets, especially dogs, exhibit behavioral disorders that share some features of Autism Spectrum Disorder (ASD) and may also share some underlying causal mechanisms
  2. Vaccines in dogs cause a wide range of diseases, and among these is the appearance of abnormal behaviors following vaccination for rabies. These behaviors resemble autism in children.
  3. Vaccination are required by law and given by veterinarians even when they are clearly not necessary. This is both very profitable and likely associated with the increase in autism-like behavioral pathologies in dogs.
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Dogs Get Autism (or something like it)
This seems to be the claim from this article that has struck skeptics as the most ridiculous or bizarre. The idea that dogs can get autism seems ridiculous on the face of it. However, part of the trouble here is the kind of issue of terminology I discussed earlier. ASD is challenging to define and identify in humans. Some of the characteristic symptoms relate to verbal and specifically human social behaviors. Since dogs cannot develop language and, obviously, are not human beings, they cannot be autistic if the word is strictly defined in terms of behaviors unique to the human species. Similarly, dogs cannot have Obsessive Compulsive Disorder (OCD), Panic Disorder, dementia, or any other psychopathology defined by behaviors or behavioral deficits unique to humans. Carried to a logical extreme, if one cannot be definitively said to experience fear, anger, sadness, or other emotions without verbally acknowledging these feelings or exhibiting them in characteristically human ways, then dogs cannot be described as having any of these feelings either.
However, dogs do share anatomic and physiologic mechanisms for generating their behavior that are homologous (meaning derived from the same evolutionary precursors and processes) to those which generate our behavior. And dogs do exhibit behaviors that look very much like fear, anger and sadness, as well as constellations and patterns of behavior that look very much like OCD, Panic Disorder, dementia, and ASD. Whether or not we choose to use the same descriptive terms for these behaviors depends more on our purposes and our concerns about the impact of this terminology on how others receive our arguments than on the question of whether the behaviors and their biological antecedents are related, which they very likely are.
The claim that dogs exhibit ASD-like behaviors is supported by citing the work of Tufts University veterinarian and behaviorist Dr. Nicholas Dodman. Dr. Dodman has published both research articles and popular books about animal behavior, and he frequently makes direct and explicit comparisons between clinical behavioral pathologies in humans and similar patterns of behavior in animals. The specific article cited in the Vaccine Reaction piece was a popular piece by Dr. Dodman in the magazine Psychology Today, Can Dogs Have Autism? Dr. Dodman addresses this question in a more academic manner through a number of scientific reports (e.g. 12). He has also studied a number of other behavioral pathologies in dogs and other species which he suggests may have meaningful similarities to OCD and Tourette’s syndrome.
I have mixed feelings about Dr. Dodman’s use of human diagnostic terminology in reference to behavior problems in non-human animals. I agree that there are striking similarities in some of the patterns of behavior he identifies, and I think investigating potential shared causal mechanisms is worthwhile. To the extent that animal models of human disease share manifestations and causal mechanisms, identifying them can improve our understanding of these diseases in humans as well as the model species. This is a standard part of medical research, and there is no fundamental reason it shouldn’t be applied to behavioral disorders.
I also think that by communicating with the general public about this kind of research can generate better public understand and support for the research and for science generally, which is desperately needed now more than any time in the past century. Dr. Dodman has had great success in sharing his passion and the subjects of his research with the public, and I think that is worthwhile even if not every hypothesis he comes up with ends up being correct.
However, I also recognize the dangers of labeling non-human behavioral disorders with diagnostic labels developed for use in people. Even when there are shared features and casual mechanisms involved, there are also meaningful differences between the human disorders and those seen in other species. A key feature in many cases of ASD, for example, involves abnormalities in language development. This is a core aspect of human behavior, and a large part of the real-world problems an ASD diagnosis creates for patients and their families. Identifying tail-chasing in bull terriers as “autism” runs the risk exaggerating or oversimplifying the similarities between the disorders, which can interfere with full and accurate understanding of them. Such use of language can also be misinterpreted as demeaning to human ASD patients. Comparisons of stigmatized human groups to animals has long been a powerful weapon against these groups, and while I have no concern that Dr. Dodman has any such ill intent in his use of human diagnostic terms, I can see how his legitimate scientific background could appear to legitimize misuse or misinterpretation of his work by others.
That is, in fact, what has occurred in the Vaccine Reaction article. While the reference to Dr. Dodman’s work on ASD-like behavior in dogs is generally accurate, it is juxtaposed to completely inaccurate claims about vaccines, including the claim that they are a causal agent in ASD. This implies that Dr. Dodman’s work supports a link between vaccination and ASD or other behavioral pathology, which it most absolutely does not.
On balance, I don’t believe the claim that dogs can get autism is as unreasonable or prima facie ridiculous as it seems to some people. I think he has some evidence to support meaningful similarities between some canine behavioral pathology and ASD, and I think further investigation of these similarities could possibly lead to better understanding of the causes and mechanisms of ASD. However, I also believe that there are important differences between canine and human cognition and behavior that mean humans and dogs cannot both be “autistic” in precisely the same sense. An animal model of a human disease is, for all its usefulness, a model, not the disease itself, and there are always differences that matter.
I see both the advantages and disadvantages to using a shared term to describe similar, and potentially causally related, behavioral disorders in humans and dogs. To some extent, it may be fair to say that dogs get autism, but when exploring the meaning of this label more fully we must acknowledge and bear in mind the differences between the species as well so we aren’t misled by a simplistic or excessive concept of equivalence between human and canine behavioral disorders.
Vaccines Cause All Sorts of Diseases, Including Rabies-like Behavior or Canine Autism
My response to this claim is far less complex and nuanced: bullshit!
To expand on that further would require rehashing lots of subjects I’ve written about before. Instead, I will say only that while vaccines can cause both minor and serious adverse effects, they do so rarely, their benefits far outweigh their risks in most cases (for core vaccines, such as rabies, for example), and there is no such thing as “Rabies Miasm,” “Chronic Rabies” or “Canine Autism” that can be blamed on rabies vaccination. Here are some posts dealing with these and other anti-vaccine claims in more detail:
Rabies Vaccines & Aggression in Dogs-Pure Pseudoscientific Fear Mongering
Thimerosal–Should I worry about mercury in vaccines for my dog or cat?
“One and Done” Approach to Rabies Vaccination is Misguided and Dangerous
What You Know that Ain’t Necessarily So: Vaccination & Autoimmune Diseases
Antibody Titer Testing as a Guide for Vaccination in Dogs and Cats
What’s the Right “Dose” of a Vaccine for Small-Breed Dogs? (and a follow-up post)
Pox Parties for Dogs: Brought to You by Veterinary Homeopaths
Routine Vaccinations for Dogs & Cats: Trying to Make Evidence-based Decisions
One additional point does need to be made, however.
VACCINES DON’T CAUSE AUTISM!!!
The evidence for this conclusion is overwhelming (e.g. 123). I contacted Dr. Dodman after seeing his work used to imply a causal relationship between autism and vaccines, and he was unequivocal in his response. He does not believe that vaccines are a cause of autism, in humans or in dogs, and he rejects any suggestion that his work might support this false claim.
More Vaccines = More Autism in Dogs
Bullshit redux. It is not even clear that dogs are being vaccinated more than in the past. Recent changes in our understanding of the average duration of immunity and other variables have led many vets to change vaccination practices, so quite a few of us are actually vaccinating less than we used to. There certainly are too many vets who haven’t kept up with the science in terms of vaccinating more than is necessary to provide protective immunity for some diseases, and revenue is likely one of many factors in this. Between changes in vaccination protocols and hesitancy about vaccination on the part of pet owners, it is as likely that vaccination rates have declined rather than increased in the last decade. However, I am not aware of any reliable data on this subject, and none was provided in the Vaccine Reaction article. Regardless of whether vaccination of dogs is increasing or declining, there is no evidence that vaccines are related to behavioral pathology in dogs, ASD-like or otherwise, and this is just another of the many false claims made in the article.
Bottom Line
There are behavioral disorders in dogs that share symptomatic and possibly causal features of behavioral disorders in humans. While the use of human diagnostic terminology in dogs is problematic, it is not unreasonable to suggest dogs may have behavioral syndromes similar in symptom pattern and causal factors to autism and other human disorders. Animal models of human disease are an established and useful element of medical research, and this can be reasonably applied to behavioral disorders if done judiciously. Dogs clearly do not get autism as it is defined and exhibited in humans, but they may well have related disorders that can provide insight into the causes and treatment of autism in humans.
Regardless of whether or not we choose to call similar or related disorders in dogs and humans by the same name, we can at least be confident of one key fact:
VACCINES DON’T CAUSE AUTISM!!!
Posted in VaccinesLeave a comment[/size]

Latest Integrative Nonsense from the Integrative Veterinary Care Journal- Spring 2017
Posted on April 5, 2017 by skeptvet
Introduction
Alternative medicine practitioners have had a lot of success marketing their methods to the mainstream veterinary profession by obscuring or downplaying the most egregiously unscientific and ridiculous of their beliefs and practices when speaking outside of their own groups. They will often claim an acceptance of scientific evidence, though not to the extent that it overrides their personal experiences or anecdotes. And they will employ the term “integrative medicine” to suggest that they consider all therapies, conventional or alternative, equally and fairly before selecting the right method for each patient. The outwardly reasonable marketing of such integrative medicine can be very effective at convincing reasonable, mostly science-based animal owners and veterinarians to take seriously methods that, when understood fully, are deeply unreasonable and incompatible with science.
However, when speaking amongst themselves, such practitioners often feel free to reveal how they really feel about science and conventional medicine and to speak more honestly about the ideas and beliefs underlying the alternative methods they integrate with scientific medicine. One of the regular functions of this blog is to put such more thorough and honest comments on display so that people considering integrative alternative medicine into their veterinary practice or their care of their own pets can have a fully informed understanding of what they are being offered.
Having collected quite a bit of such material, I have created a new thematic post to collect all of it, which you can find here: Alternative and Integrative Medicine Revealed
The Latest Pseudoscientific Nonsense from the IVC
Today’s selection comes from the latest issue of the faux journal IVC (Integrative Veterinary Care Journal).  I’ve written about IVC before, and it’s a rich source of the kind of honest anti-science sentiment that pervades alternative veterinary medicine but is seldom publicly expressed. In the latest issue, the nonsense begins right up front, with the editorial by Christina Chambreau, a homeopathy I’ve written about before as well.

Quote:…it was a huge relief when I learned that holistic modalities are very successful replacements for surgery and drugs…
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Pretty clearly an “alternative” rather than an “integrative” view. Despite claims to meld  science-based and alternative therapies, many so-called holistic vets firmly believe alternative methods are frequently safer and more effective than conventional medicine and will replace science-based treatments with alternatives rather than integrating them.[/size]

Quote:Understanding the energetic basis behind holistic approaches is especially important for these serious ailments. Dr. Janet Gordon palm delves into the physics of Newtonian and Quantum sciences to remined us that our goal is bigger than merely resolving symptoms – it’s to guide the cells back to optimal health and harmonic resonance.”
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This refers to a bizarre article on “energy medicine” which I will address shortly. It makes sloppy and disingenuous use of a grade-school conception of quantum physics to justify quasi-religious mystical beliefs that have nothing to do with actual physics. This kind of dressing up of spiritual beliefs in scientific clothing is a key feature of the integrative medicine marketing strategy which allows practitioners to conceal from colleagues and clients that they are effectively selling faith healing instead of medicine. Dr. Chambreau continues this nonsense as a means to promote her favorite useless therapy, homeopathy.[/size]

Quote:Dr. John Saxton shows us the effectiveness of homeopathy to rebalance the quantum field…
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Faux Physics for Neurologic Disease
The article Dr. Chambreau first refers to in her editorial introduction is a classic example of the bizarre misuse of poorly understood metaphors from quantum physics to justify quasi-religious medical nonsense. Quantum physics is a field most of us can only access through metaphor, but a real understanding of its principles and implications requires a facility with higher mathematics very few veterinarians or pet owners are likely to have. Unfortunately, not understanding what she’s talking about doesn’t restrain Dr. Gordon Palm from making ridiculous claims about quantum physics supporting her personal spiritual and therapeutic beliefs.[/size]

Quote:Conventional medicine is based on Newtonian science, in which the body is a veritable solid object surrounded by space. Current quantum physics shows that the body is more space than solid matter. Your choice of science will influence your treatment plans…The conventional approach focuses on treating physical symptoms rather than the energetic root causes.
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The distinction between Newtonian and quantum physics is used here to imply a distinction between physical symptoms and non-physical causes, a version of the philosophy of dualism. This is a philosophical and religious concept, not a scientific fact supported by the evidence and logic of quantum physics.[/size]

Quote:We are primarily energetic electromagnetic beings, and secondarily physical beings.
Environmental and ingested pollutants, electromagnetic field radiation (EMFs) genetically modified organism (GMO) grains…disturb the normal resonance frequencies of healthy tissue.
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Apart from the evidence-free claims about negative health effects from GMOs and EMF, the distinction given here between “electromagnetic” and “physical” is false because electromagnetic phenomena are part of the physical universe. She is essentially using “electromagnetic” and a substitute for “spiritual” so that she can claim magical therapies with no real physical effects still treat disease. This spiritualism is even more explicit in the following section:[/size]

Quote:Regardless of a patient’s primary complaint, all enlightened veterinarians would agree that the most important tool we can apply to affect outcome and healing success is the power of our intentions. Literally falling in love with the animal can be transformative. He receives our positive vibrations through our body language and the relaxation of our energy.”
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This is an example of the quasi-religious, mind-over-matter doctrine which suggests that we influence the outcome of disease by our thoughts and mysterious “energy.” Some lip service is given to the more plausible idea that our body language influences stress levels in our patients, but that is a shallow scientific camouflage for the underlying idea that our thoughts have magical influence over physical health and disease in our patients.
Dr. Gordon Palm goes on to list a variety of alternative therapies for neurological diseases none of which have been scientifically demonstrated to be safe and/or effective. These include:
Ozonated fluids- discussed on this blog here
Essential Oils- discussed here
Tuning forks for balancing chakras- too ridiculous to bother discussing
PEMF- discussed here
Homeopathy- thoroughly debunked over and over again
Veterinary orthopedic Manipulation- discussed here
Cold Laser- the only halfway reasonable option mentioned, discussed here
This is not the integration of scientifically validated alternative therapies with conventional medicine. This is the use of the word “quantum” and some vague hand-waving to create the poor-quality illusion that a collection of quasi-religious beliefs and unproven or disproven therapies should be taken seriously as options for animals with serious neurologic disease. That is the reality underlying much of the claims of “integrative medicine.”
Bottom Line
The rest of the IVC issue continues the trend, discussing the worthless nonsense of homeopathy as if it could be a legitimate treatment for seizures and other neurologic conditions, recommending the mythical mumbo-jumbo of Traditional Chinese Medicine, pushing the nonsense of Standard Process glandular supplements, an generally showcasing the underlying truth of the integrative medicine concept, as a Trojan Horse for smuggling unproven and unscientific alternative therapies into mainstream practice without going to the trouble of demonstrating scientifically that they have any value.
Posted in General2 Comments[/size]

Alternative & Integrative Medicine Revealed
Posted on April 5, 2017 by skeptvet
Alternative medicine practitioners have had a lot of success marketing their methods to the mainstream veterinary profession by obscuring or downplaying the most egregiously unscientific and ridiculous of their beliefs and practices when speaking outside of their own groups. They will often claim an acceptance of scientific evidence, though not to the extent that it overrides their personal experiences or anecdotes. And they will employ the term “integrative medicine” to suggest that they consider all therapies, conventional or alternative, equally and fairly before selecting the right method for each patient. The outwardly reasonable marketing of such integrative medicine can be very effective at convincing reasonable, mostly science-based animal owners and veterinarians to take seriously methods that, when understood fully, are deeply unreasonable and incompatible with science.
However, when speaking amongst themselves, such practitioners often feel free to reveal how they really feel about science and conventional medicine and to speak more honestly about the ideas and beliefs underlying the alternative methods they integrate with scientific medicine. One of the regular functions of this blog is to put such more thorough and honest comments on display so that people considering integrative alternative medicine into their veterinary practice or their care of their own pets can have a fully informed understanding of what they are being offered.
Having collected quite a bit of such material, I have created a new thematic post to collect all of it, which you can find here.
Science Through the Looking Glass- The Integrative Veterinary Care Journal
The University of Florida’s Integrative Medicine Service: Good Science or a CAM Trojan Horse?
UT Integrative Veterinary Medicine Fellowship: A Case Study in Alternative Medicine Propaganda
Integrative Medicine or Bait-and Switch?
Integrative Veterinary Cancer Care: Are Claims without Evidence Dishonest?
Dr. Nancy Scanlan Shows us How to Talk Sciency Without Actually Accepting Science
What Do Holistic Vets Say About Science and Evidence-based Medicine?
The Dangerous Allure of Alternative Therapies for Pets with Cancer
Dr. Barbara Royal Reminds us that the AHVMF Opposes Science-Based Medicine
The 2012 AHVMA Annual Conference: An illustration of Conflicts between Science-Based Medicine and Holistic Veterinary Medicine
The American Holistic Veterinary Medical Foundation: Science or Salesmanship?
Holistic Veterinary Medicine: A Variety of Faith Healing
CAM Vets Attacking Conventional Veterinary Medicine
The Marketing of Veterinary Homeopathy
What “Experts” in Homeopathy are Supposed to Believe
The Problem of Negative and Inaccurate Advertising of Alternative Veterinary Medicine
Integrating Myths and Nonsense with Standard Advice for Allergic Pets
The Latest Integrative Nonsense from the Integrative Veterinary Care Journal- Spring 2017 Issue
Posted in Topic-Based SummariesLeave a comment

Does Injection at Acupuncture Sites Work Better Than Needling Alone?
Posted on March 31, 2017 by skeptvet
Introduction
I’ve recently seen a couple of patients who were treated by Traditional Chinese Veterinary Medicine (TCVM) vets at other hospitals. The records from these vets include the usual pseudoscientific nonsense describing their conditions, such as “Rebellious Spleen Chi” or “Kidney Qi Deficiency.” And these patients have typically been given the usual untested and unregulated herbal remedies TCVM vest use, despite the serious risks these can present (in fact, a local woman was recently killed by a toxic herbal tea from a TCM apothecary shop). And of course, these patients received acupuncture treatment. However, these particular vets seem especially fond of a twist on the usual acupuncture practice that I’ve seen a few times before—the injection of Vitamin B12 into supposed acupuncture points.
I’ve discussed previously the general unreliability of the pre-scientific religion and folklore that make up TCVM theory. I’ve also investigated the evidence concerning acupuncture in exhaustive detail as part of my certification in veterinary medical acupuncture. While there is some limited evidence for possible clinical benefits to a very few needling practices, especially involving electrical stimulation of peripheral nerves, in general the value of acupuncture is probably slight, if any, and the use of TCVM to guide it is worthless. My focus here, then, is whether there is any advantage to injecting vitamins or other substances into purported acupuncture points (which quite likely don’t exist as discrete, consistently identifiable locations anyway; 12).
The Evidence
There is, of course, some research literature comparing acupuncture injection to dry needling. Whether it makes sense to do such studies given the uncertainty about the theory and clinical effects of acupuncture in general is a serious question. In any event, such studies are not going to be very convincing when they only compare injection to standard acupuncture without some form of non-acupuncture or sham acupuncture control group. Often, such studies lack such controls, and so they may well only be comparing one placebo to another.
Another problem with the acupuncture injection literature is the choice, in some studies, to inject pharmaceuticals at proposed acupuncture points. By itself, again without proper control groups for comparison, this is more a comparison of drugs versus acupuncture than acupuncture injection versus plain acupuncture.
Finally, most of the acupuncture injection literature suffers from the usual weaknesses of acupuncture studies, not only lack of appropriate control groups but inadequate blinding, randomization, statistical analysis, or other flaws that leave the studies vulnerable to bias.
Here are a few examples:
Wade C, Wang L, Zhao WJ, et al. Acupuncture point injection treatment of primary dysmenorrhoea: a randomised, double blind, controlled study. BMJ Open. 2016 Jan 5;6(1):e008166. doi: 10.1136/bmjopen-2015-008166.
This one compared three groups:
Vit K injection at acupuncture point on both legs and saline in the buttock
Saline near but not at acupuncture point in both legs and Vit K in the buttock
Saline at acupuncture points on both legs and in the buttock
The goal was to measure changes in discomfort associated with menses. There was some blinding, in that patients and doctors didn’t know what they were injecting, but of course the doctors knew whether or not they were making the injection at an acupuncture point, so at least one group was not blinded for the doctors.
As usual, all groups reported less discomfort that before treatment, so placebo effects were certainly at work. The authors make much of the fact that there was a statistically significant difference between the group getting Vitamin K at acupuncture sites and the other groups. However, the differences between this group and the other two were from 1.1-1.8 points on an 11-point pain scale. By comparison, the control groups both improved by 4.5-5 points on this scale from baseline during the hour after treatment. This means the placebo effects were 4-5 times greater than any effect from the treatment itself, which doesn’t exactly suggest a meaningful real-world treatment effect.
Chen CY, Lin CN, Chern RS, et al. Neuronal Activity Stimulated by Liquid Substrates Injection at Zusanli (ST36) Acupoint: The Possible Mechanism of Aquapuncture. Evid Based Complement Alternat Med. 2014;2014:627342. doi: 10.1155/2014/627342. Epub 2014 Mar 6.
This one starts with the assumption that injection of drugs at acupuncture sites is more effective than acupuncture alone due to some kind of synergistic effects (an unproven assumption, like so many in alternative medicine). The study aims to identify the mechanism of this assumed effect.
The study compared injection of saline, Vitamine B1, Vitamin B12, and bee venom to plain needling at an acupuncture point. The outcome measured was the activity of a gene in the spinal cord (the study was done in rats). The assumption here was that greater gene activity meant greater stimulation at the acupuncture point, though what clinical relevance this would have is not obvious or addressed by the authors.
The results indicated no difference between the various treatments with the exception that bee venom appeared to generate more gene activity in the spinal neurons than the other forms of stimulation. The grand conclusion, then, would be that acupuncture injection is generally no different than plain needling except if you use something specifically designed by nature to irritate nerves like bee venom! It’s hard to see, though, how this sort of research justifies the practice of acupuncture injection in real-world patients.
There are a moderate number of similar studies that have the same sorts of limitations, but none that provide clear, high-quality data suggesting that acupuncture injection has significant clinical advantages over dry needling. Reviews of the acupuncture injection literature for specific medical conditions are typically inconclusive due to the lack of good-quality research. For example:
Wang LL, Guan L, Hao PL, et al. Acupuncture and vitamin B12 injection for Bell’s palsy: no high-quality evidence exists. Neural Regen Res. 2015 May;10(5):808-13. doi: 10.4103/1673-5374.156987.
“Because of study bias and methodological limitations, [our] conclusion is uncertain…”
Wang M, Gao YH, Xu J, et al . Zusanli (ST36) acupoint injection for preventing postoperative ileus: A systematic review and meta-analysis of randomized clinical trials. Complement Ther Med. 2015 Jun;23(3):469-83. doi: 10.1016/j.ctim.2015.03.013. Epub 2015 Apr 13.
“ST36 acupoint injections with various agents may have a preventive effect for POI. Safety is inconclusive as few of included trials reported adverse events. Due to the poor methodological quality and likely publication bias further robust clinical trials are required to arrive at a definitive conclusion.”
Bottom Line
Even overlooking the uncertainties about the meaning of Traditional Chinese Medicine theories and metaphors, the existence of acupuncture points as discrete and definable entities, or the clinical effects of acupuncture per se, there is little evidence to support the idea that injection of various substances at acupuncture points has significant advantages over needling alone at these points. Of course, the injection of drugs at acupuncture points may have greater effects than needling alone, but this is more likely due to the pharmacological effects of the drugs themselves, having little or nothing to do with the identification of the injection site as an acupuncture point.
Posted in Acupuncture2 Comments

Should Herbalism Be a Recognized Specialty in Veterinary Medicine?
Posted on February 28, 2017 by skeptvet
Introduction
As regular readers will know, herbal medicine is the area within complementary and alternative medicine I am most sympathetic to. (WWW.VERSAILLESKENNELS.COM) Specialise in this area of vet medicine 

Plants obviously contain chemical compounds that can have significant physiologic effects, for good or ill. And many conventional medicine have been derived from such plant compounds. The idea, then, that the medicinal use of plants and plant-derived substances might have real value is plausible, even likely, in my opinion. So far, very few uses of herbal remedies have been scientifically validated (as distinct from isolated and purified compounds derived from plants and used as drugs). However, I believe there is significant potential in plants as sources of medicines, and I support rigorous scientific research in this area.
Unfortunately, herbal medicine as a discipline is often not focused on scientific evaluation of the potential risks and benefits of herbal remedies. Instead, it tends to be uncritically accepting of truly alternative theories about health and disease and of traditional or anecdotal evidence alone as the foundation for the selection and use of plant products as medicines. Traditional Chinese Medicine (TCM or TCVM for the veterinary variety), the Indian folk tradition of Ayurveda, and other dominant approaches in herbalism often reject scientific principles or evidence in favor of mystical folk models of health and disease, and such herbalists often view scientific evidence only as a tool for gaining wider acceptance of their practices, not for determining which are effective and safe and which are not. As is true in so many areas of CAVM, herbal medicine practitioners tend to find science useful only insofar as it supports their beliefs, but they tend to reject negative findings or the failure to find good evidence for their practices and persist in these beliefs and practices based on personal experience, tradition, and anecdote regardless of what science says.
There are also other serious problems with the area of herbal medicine as it currently exists. There is virtually no regulation and very little scientific investigation of herbal products. When sampled, many herbal products turn out not to contain what they are supposed to contain, and contamination with toxic heavy metals, potentially poisonous plant chemicals, and even conventional pharmaceuticals appears to be common (12345). There is evidence that these unregulated and untested remedies cause significant injury and illness (678).
So while I think there is significant medical potential in plants and their incredible array of natural compounds, the herbal medicine industry (and make no mistake, it is a multi-billion dollar industry: 910) as it currently exists is largely unscientific and insufficiently regulated and herbal remedies and supplements have very few proven benefits and some serious risks. The unfortunate tendency of herbalists is to rely on tradition, anecdote, and unscientific folk theories about health to guide their use of untested plant remedies and to utilize science primarily as a marketing tool rather than a necessary means of developing safe and effective herbal treatments. There are certainly individual exceptions, but this is the general character of the industry.
I was therefore both interested and concerned when I recently learned that the American College of Veterinary Botanical Medicine (ACVBM) is in the process of seeking recognition as a veterinary specialty organization. The American Board of Veterinary Specialties (ABVS) is the unit of the American Veterinary Medical Association (AVMA) that recognizes areas of specialization in veterinary medicine and the organizations that certify individual veterinarians as specialists in these areas. Similar organizations perform his function in other countries (such as the European Board of Veterinary Specialisation (EBVS) Australasian Veterinary Boards Council (AVBC)) and in human medicine (e.g. American Board of Medical Specialties  and the European Union of Medical Specialties).
What is a Medical Specialty?
The purpose of official recognition for medical specialties is so that patients and pet owners can know which clinicians are likely to have a high-level of training or expertise in a particular medical area. In human medicine, specialists are often very highly focused on narrow subjects. After more than a decade of education and training, for example, surgeons may only perform a few procedures on one part of the body. While there are some problems with excessive specialization, it is clear that medicine is far too large a body of information, tools, and techniques for any one person to master it all. Specialists do fewer things, and they tend to do them better than more generally trained and experienced doctors.
In veterinary medicine, specialization is less common than in human medicine due to economic factors. Because specialists, and their additional training and experience, are more expensive than general practice vets, many vets without board certification in a specialty will still commonly work in areas that have recognized specialists. I do cardiac ultrasounds, treat cancer with chemotherapy, perform a wide range of surgical procedures, and manage chronic skin conditions despite the fact that there are recognized specialists in the areas of veterinary cardiology, oncology, surgery, and dermatology. There are pros and cons to choosing a specialist or a generalist to treat your pet for particular health issues, but there is no question that specialists have deeper knowledge and greater experience and expertise in their specialty disciplines than I or other general practitioners have.
The concept of expertise is, unfortunately, under some attack generally these days, especially in the U.S. (e.g. 11) There seems to be a feeling that anyone can be an expert, or declare themselves to be, by virtue of their independent study or experience without going through a recognized educational and training program. This applies more in areas in which the subject and outcomes are not clear and distinct. Few people would attempt to fly a jet or perform open heart surgery without the appropriate specialized training because the consequences of inadequate skill and expertise are obvious and dramatic. However, people with little or known scientific or medical training often feel equipped to doubt or deny the consensus among true specialists in areas like climate change or medicine.
In CAVM, the concept of specialization is especially problematic in a different sort of way. Homeopaths, Chinese Medicine vets, even psychics and astrologers will often declare themselves to be “experts” in their fields and deny the legitimacy of criticism from others, regardless of the credentials of critics or the evidence presented, if their critics do not have the same training and experience in these fields. However, if homeopathy and TCVM are just sets of made-up ideas without scientific validity, what is the value of expertise in these subjects?
The analogy I often use is that of the Catholic priest as an expert in Catholicism. There is no question a priest has superior knowledge and experience in the details of the Catholic faith, so in some sense he is an expert. However, if you are a Jew or a Muslim or an atheist, this expertise is not very meaningful, and it is unlikely to convince you that the priest is right about the details of religious controversies. Similarly, while I agree homeopaths know more about homeopathy than I do, I know enough to understand the subject of their expertise is an unscientific fantasy, so I have no obligation to defer to their views on the controversies about it.
Should Herbalism Be a Recognized Veterinary Specialty?
All of this is intended to provide a context for answering the question, “Should herbalism be recognized as a veterinary medical specialty?” This has to be answered both generally and in terms of the specific application of the ACVBM for recognition as a specialty organization by the ABVS.
In general terms, I think specialty status for herbal medicine is not warranted because the evidence base for the area is too limited and it is still plagued with deep-rooted unscientific concepts and practices. In theory, such an area could be a legitimate scientific specialty if the attitude towards science changes and the evidence base is properly developed, but that is not yet the case. No herbalism specialty is recognized in human medicine or veterinary medicine in the US, Europe, or Australia, which would make recognition of the ACVBM unprecedented.
In terms of the specific application, it is clear after reading it and investigating the provenance and the leadership of this organization that recognition of the ACVBM as a specialty organization would be a serious mistake. I will discuss why in detail below, but this organization is dominated by TCVM vets and key figures in the American Holistic Veterinary Medical Association (AHVMA), a deeply anti-science organization that promotes every imaginable alternative practice, from herbal medicine to homeopathy and faith healing. Most of the leadership practices multiple varieties of CAVM, not only herbal medicine, and many have made worrying comments about science and conventional medicine that suggest they fundamentally don’t accept the principles and practices of science-based medicine. This application is less about making herbalism a scientific specialty within veterinary medicine than it is about getting a foot in the door to obtain the AVMA’s imprimatur of mainstream legitimacy for alternative veterinary medicine of all sorts without demonstrating the truth of their theories or the safety and efficacy of their methods through sound scientific research.
The ACVBM Application for Specialty Status
The ABVC is the AVMA organization that recognizes veterinary medical specialties. It consists of representatives from the existing specialty groups and non-voting members from a couple of other organizations. The ABVS has a detailed description of the standards for obtaining specialty recognition. Unfortunately, and in keeping with the general approach of the AVMA to support veterinarians in virtually anything they choose to do but to assiduously avoid setting standards for veterinary medicine, these criteria go into great detail about the mechanisms and procedures for functioning as a specialty board but make little mention of science or any criteria for judging the legitimacy of a proposed specialty area. Obviously, any organization can follow a template for governance and for administering examinations and such, so being able to meet these standards says nothing about the legitimacy of the subject area. The few sections that seem to address this more important issue are these:
The AVMA American Board of Veterinary Specialties (ABVS) is the umbrella organization for veterinary specialties within the United States. It is composed of one voting representative from each of the AVMA-recognized veterinary specialty organizations, plus non-voting liaisons from the Association of American Veterinary Medical Colleges and the AVMA Council on Education.
For a veterinary specialty organization (or their independent certification board) to be recognized by the AVMA, they must:

Quote:Demonstrate that improved veterinary medical services will be provided to the public.
Serve a clearly defined need within the profession.
Represent a distinct and identifiable specialty of veterinary medicine, one that is supported by a base of scientific knowledge and practice that is acceptable to the profession and the public. [emphasis added]
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Let’s take a look at the ACVBM application and some of the problems and questions it raises, including the extent to which it might or might not meet the ABVS criteria for recognition.
Would Recognition Improve Veterinary Medical Services to the Public?
The ACVBM medicine asserts that “improved veterinary medical services” will be available to animal owners by the recognition of ACVBM based on the assumption that herbal medicine is a safe and effective tool for improving patient care. Unfortunately, this is not a scientifically demonstrated assertion. The debate about the research evidence for herbal remedies is a complex one, and the devil is in the details. There are many published research studies that appear to show benefits to herbal remedies and supplements. However, there are many published studies support the same claims for homeopathy, but a detailed examination of the literature shows that homeopathy almost certainly has no real benefits at all ([color=#743399]12
13). The ability to cite lots of papers does not by itself show a robust scientific support for a specific medical approach.
While I have not examined the herbal literature in as much detail as that pertaining to homeopathy, I have studied the main textbook for veterinary herbal medicine and looked at many of the specific studies cited in the ACVBM application. The evidence is generally weak and inconsistent, it often does not support the claims it is cited by the ACVBM to support, and overall the body of robust, consistent scientific evidence supporting herbalism that the ACVBM claims does not exist. There is good evidence for a few specific remedies used for a few specific conditions. But there is no evidence to support most of the theoretical foundations on which most herbalists rely. TCVM as a diagnostic and therapeutic system, the concept of “tonics,” the general principle that mixtures of plant compounds given in raw form are safer and more effective than isolated compounds used as drugs, and many other key concepts herbalists rely on run counter to established science or are, at best, unproven beliefs.
So the claim that giving greater legitimacy to the group would enhance the care provided to the public rests on shaky ground. You cannot improve care by calling pseudoscience a specialty, and much of the popular approach to herbalism, especially the dominant approach of TCVM, is pseudoscience.
Is Herbalism Supported by Scientific Knowledge and Practice?
I have already answered this question to a certain extent. There is much scientific evidence relating to specific compounds or remedies, but the vast majority of herbal remedies remain untested outside of lab animals. And the concepts upon which diagnosis and prescribing by herbalists rests are not only not yet validated but typically inconsistent with a scientific understanding of health and disease. However, I want to explore in more detail why the claims to a scientific approach made in the ACVBM application appear disingenuous and generally untrue.
For one thing, the ACVBM claims it would become the specialty responsible for pharmacognosy, the practice of identifying medicinal compounds in plants. This is currently the domain of pharmacology, a recognized specialty area (under the [url=http://www.acvcp.org/][color=#743399]American College of
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