"Indeed, slavish adherence to any one path is usually how we get ourselves into trouble."

Very well said Dr. Khuly. There is way too much dogma in veterinary medicine, at both ends of the spectrum. It's so easy to get sucked into believing extremists who think their way is the only way, after all, they are much more vocal, confident in their approach and perfectly willing to spoon feed it to you. But I find that, as usual, the right answer almost always lies somewhere in the middle. I appreciate an open minded but sensible approach to treatment, no matter who it's coming from. Most importantly, I appreciate a vet who can set their ego aside and respect my wishes.

I have no issue going the alternative/holistic route, when something doesn't seem to be working.

I wonder, do you also recommend Hills Science Diet?

Western and holistic medicine can compliment each other nicely, and I agree with Lindsey that there are too many extremes on both sides of the spectrum.

I absolutely LOVE the vet I found in our area (Dr. Tammy Barron in Crystal River, FL - you're wonderful if you're reading this). Dr. Tammy has a conventional practice, however, she knows and respects that I choose to go the natural route whenever possible, and never has she tried to interfere with that choice other than offering the options that conventional medical can offer should we choose or need to go that route. I rely on western medicine as my backup (you know - save the big guns as a last resort). This is the European approach and one that just makes sense to me: treat what's causing the ailment and not just put a bandaid on the ailment itself.

I think Dr. Khuly, that you and Dr. Tammy are a rare breed of vets out there that are flexible and humble enough to allow freedom of choice to the pet owners - realizing that they may have enough scruples to make a balanced decision for their pet and then respecting that decision once it's made. You're to be commended - anyone that goes to you is fortunate to have a good vet like that.

I have to agree wholeheartedly with Lindsey.

@Chaikat and anyone else who is going to post with guns blazing - there are lots of Dr. Khuly posts that incite a certain amount of vet bashing... this should not be one of those posts. Not once did she say to her client "That 'natural' stuff is hooey and you're an idiot for trying it. Here, take some Science Diet samples..."

Instead, she did exactly what I think most of us would have done in her position. Offered the opinion of a true expert on the matter.

I should also add that had she jumped on the "you're an idiot" wagon I can't say I would have blamed her. Natural treatments for hyperthyroidism are... well, hooey. Sure there are several compounds that are effective at combating the side effects of conventional treatment, but there is no miracle treatment that causes no harm.

In other situations, however, natural treatments very likely should be considered before allopathic treatments are attempted. Issues like eye and ear irritation, skin issues, diarrhea, spay incontinence and mild epilepsy all respond well to "holistic" or "natural" treatments. Issues like hyper/hypo-thyroidism, cancer, Addison's and Cushing's generally do better when treated with drugs and supported by natural supplements.

What makes Dr. Khuly different is her acceptance of a method that she herself does not consider very important (if you did, you'd study it, no?). Many vets don't offer such open minded service.

I'm lucky that my vets respect my wishes when trying alternative methods. Frankly when my Sunny had a flareup of IBD the traditional vets could do very little. After I had spent $1000 and the dog was no better, I contacted a highly recommended holistic vet. She healed Sunny, and he continues to be treated with a combination of traditional and non-traditional meds. It's great when vets are open-minded about alternatives. After all, the primary consideration is healing the pet.

I liked this post very much Dr. Khuly. As some others have said, looking at both sides and arriving somewhere in the middle to best serve the pet and client is the way to go. Your patients are lucky to have you! I'm fortunate that my vet respects the different supplements I use AND the fact that I always communicate with him what I'm using, checking his input on it etc. Thanks again for this great post! Nannette

To the surprise of no one, I'm sure, I disagree with several of the unspoken assumptions behind this post.

1. Being "open-minded" means accepting the legitimacy and validity of alternative practices.
No, being open-minded means accepting that alternative methods MIGHT work, not that they do work. These methods need to prove their effectiveness by the same scientific standards as anything else we offer our clients. Thousands of years of applying methods believed to be effective based on tradition, personal experience, and other less reliable standards failed to extend the average lifespan, reduce infant mortality, eliminate infectious diseases like polio, or accomplish any of the other truly amazing things scientific medicine has done in the last 200 years. It is not closed minded to suggest that scientific standards of proof work better than other ways of testing medical therapies.
2. Believing scientific standards of evidence are more reliable than tradition is "slavish adherence to one path."
I am always mystified when people view thinking critically and skeptically about unproven medical treatments as necessarily being motivated by dogma, prejudice, arrogance, or money. Why is it so hard to accept that a skeptical approach is motivated by the belief that we can actually know what works and what doesn't but only if we use the most reliable methods of testing, which have proven to be those of science? Why is it hard to understand that humility lies not in taking other people's word for the safety or effectiveness of a therapy, or in trusting our own experiences, but in acknowledging that human beings are fallible and easily fooled, and that the reason scientific ways of testing are more likely to get us the right answer than other methods is because they accept and compensate for our personal weaknesses? How is it dogmatic to say "Ok, maybe you're right, now prove it" and not dogmatic to say "We've done this for a thousand years, so it must work?"

3. There is such a thing as "Western" medicine.
Sorry, but antibiotics and vaccines work for anyone, anywhere in the world regardless of whether they believe in these methods. There is not place, no culture that has not employed and benefited from modern science, and I consider it a form of cultural prejudice ("orientalism" as the sociologists would say) to claim that somehow what works in medicine for one culture might not work in another. We are all truly the same in our bodies, so while there certainly are differences in cultural beliefs about health and disease, and while cultural values must be integrated into how we help people cope psychologically with illness, medicine either works or doesn't regardless of where it comes from or what we believe about it.

It's a good thing that the holistic veterinarian you recommended was able to convince the client to pursue an effective treatment for such a treatable disease. It's a shame that somehow that doctor's association with less well-proven, less scientific approaches to medicine somehow made their advice more trustworthy than yours even when it was the same advice. To me, that says a great deal more about the role of irrational beliefs and politics in the conflict between scientific and alternative approaches to medicine than it says about the true effectiveness or safety of either one.
People have beliefs about what is safe and what isn't, what is harmful and what isn't, that aren't always based on the truth. They tend to believe "natural" and "holistic" somehow mean "safe" even though there's no good reason to believe this. The reason alternative and mainstream medicine are incompatible has nothing to do with which elements of each are effective and which aren't. It is a philosophical and political divide. Alternative methods are simply those that people choose to believe in regardless of the scientific evidence for or against them. Some may very well be effective, many probably aren't (homeopathy, Bach flower essences, and many others have been definitively disproven). But the reason they get a separate category, a "parallel" profession to apply them, is because they are trusted for reasons that have nothing to do with science. They meet a philosophical or spiritual need that has nothing to do with whether or not they work to treat the body. Fair enough, as long as we are clear about this. This is fair enough, so long as we don't make the mistake of confusing our philosophy or our psychological needs with the truth about the physical world.

Great post Patty, I enjoyed it very much.

I understand why you choose to term these approaches the way you did (because everyone else does it the same way and you want to be understood of course) but it always strikes me as funny that "Western" medicine is considered "proven" and mainstream while "eastern" or "herbal" medicine is considered somehow weird, untested and unproven.

Western medicine was killing 50% of women giving birth in Vienna General only couple of hundred years ago. http://en.wikipedia.org/wiki/Ignaz_Semmelweis

Doctors were advertising and recommending cigarettes only few decades ago.

Western medicine was performing unnecessary knee surgeries and charging thousands of dollars to achieve the same effect as a placebo surgery.

I can go on and on....

You take a very deferential and measured approach to both which I appreciate...I just figured Id point these things out so that we dont put all of our eggs in one basket is all :-)

"Open-mindedness" is a virtue in the social/personal realm. It's good to be open to other people's ways and habits on a personal level.

But scientifically, being open-minded is a flaw, if that means you accept new information uncritically. It is not only intellectual laziness, but it is UNETHICAL to accept new methods of diagnosing and treating disease without demanding full scientific scrutiny. And when some methods fail to live up to the claims of their proponents, it is UNETHICAL to continue to promote those treatments. (See homeopathy, Reiki, T-touch, etc., etc).

SkeptVet is correct. The use of so-called complementary and alternative medicine is really about faith and belief. That's ok as far as it goes, but many CAM practitioners fraudulently cloak their methods in the garb of Science, when in fact there is no science behind it at all. I would have no problem with CAM if there were full disclosure. The problem is, the exact opposite is true. CAM proponents cloud the air with conspiracy theories, anecdotal evidence, vague pseudo-scientific language, and personal attacks, whilst providing minimal hard evidence.

Why is it that when I question the efficacy of a drug or surgery, I can have a reasonable discussion with others about the validity of using that treatment, but when I question CAM practices, people attack me with emotional zealotry?

SBM

There are flaws in traditional medicine. There can be no doubt that we aren't perfect.

But to point out those flaws does not prove the validity of CAM. It shows why many people are so desparate for SOMETHING, ANYTHING to help themselves, but that doesn't mean CAM is the answer.

One of the strengths of traditional medicine is that we admit and learn from our mistakes. Can the same be said to be true of CAM? If you never admit a mistake, how can you learn from it?

SBM

Dogan,

"it always strikes me as funny that "Western" medicine is considered "proven" and mainstream while "eastern" or "herbal" medicine is considered somehow weird, untested and unproven."

I don't consider this an accurate statement of the typical skeptical response to alternative medicine. No one can prove or disprove big, vague, heterogenous categories like "Western medicien" and "Eastern medicine," which is part of why they aren't useful categories. Individual interventions, such as drug therapies or diagnostic tests or recommendations concerning nutrition, etc, can be examined in a systematic way to demonstrate they are correct or incorrect. The difference between mainstream and alternative medicine is simply that science-based medicine accepts the need for such testing and is willing to reject even long-standing beliefs or practices when the evidence warrants, including those examples you list. In contrast, much of alternative medicine is justified regardless of the results of scientific testing because it is enduring historically or widely believed, despite the fact that popularity or long-standing practice are neither reliable guides to the truth of a claim. As I pointed out above, the difference is one of epistemology, the philosophy of how one determines what is true, not the supposed differences in the underlying nature of health and disease so often claimed.

There certainly are some practitioners of alternative medicine who have embraced the philosophy of following the evidence where it leads and discarding practices that cannot prove themselves. Edzard Ernst is a prime example and, not surprisingly, he is nearly universally excoriated in the alternative medicine community for his honesty about the state of the evidence.

What do the terms "Alternative, western, natural" really mean? What qualifies a procedure or treatment to be called one or the other? If a natural/alternative/chinese treatment that was previously unproven scientifically but underwent scientific testing and was subsequently proven to be efficacious by scientific method (double blind study) would it then be considered "wetern".

I always grin when people talk about 'natural' approaches and have the urge to point out snake venom is natural and probably organic to boot! Doesn't make it safe or effective.

That said, clinical vetmed is not just about medicine. It's about people, their views, wishes, and risk and expense tolerance. If an owner wants to try something that is not in the Merck manual but commonly available, I don't think you do anyone a service by dismissing it out of hand. The lovely thing in my mind is that most alternative therapies are at worst benign. There are exceptions, but most will not cause further injury or illness to the patient. It is not proven that they confer any health benefit in most cases, but they DO confer owner benefit. Owners like them and many pets tolerate them very well. My untested, unproven, unscientific impression is that these options also really do help some patients, especially with regards to modalities like massage. In practice, you're not just treating a disease or doing science- you're going for comfortable healthy pets and happy owners.

Further, even if you DON'T agree with CAM, you still need to be educated enough to discuss it intelligently with your clients so you can steer them towards what you do think is appropriate. A survey I ran with current vet students (pending publication) shows that most have little training in CAM and got their info from Dr. Google, just like everyone else. Post-grad surveys show that the newbie vets from our school felt like this lack of education was a serious oversight. So, know thy friend or know thy enemy in this case, depending on your own stance.

I always grin when people talk about 'natural' approaches and have the urge to point out snake venom is natural and probably organic to boot! Doesn't make it safe or effective.

That said, clinical vetmed is not just about medicine. It's about people, their views, wishes, and risk and expense tolerance. If an owner wants to try something that is not in the Merck manual but commonly available, I don't think you do anyone a service by dismissing it out of hand. The lovely thing in my mind is that most alternative therapies are at worst benign. There are exceptions, but most will not cause further injury or illness to the patient. It is not proven that they confer any health benefit in most cases, but they DO confer owner benefit. Owners like them and many pets tolerate them very well. My untested, unproven, unscientific impression is that these options also really do help some patients, especially with regards to modalities like massage. In practice, you're not just treating a disease or doing science- you're going for comfortable healthy pets and happy owners.

Further, even if you DON'T agree with CAM, you still need to be educated enough to discuss it intelligently with your clients so you can steer them towards what you do think is appropriate. A survey I ran with current vet students (pending publication) shows that most have little training in CAM and got their info from Dr. Google, just like everyone else. Post-grad surveys show that the newbie vets from our school felt like this lack of education was a serious oversight. So, know thy friend or know thy enemy in this case, depending on your own stance.

(and the site LOVES to eat/delete/refuse to post my comments?)

I am an Animal Therapist and I do use complementary modalities, so I was really interested what you have to say.

Unfortunately there are a number of black sheep out there which still cause more damage than good. But more and more well-trained practitioners get out there as well, so I do believe there will be a change soon.

I prefer to use the word 'complementary' instead of 'alternative' for two reasons:
1. they have a different meaning and
2. I usually work together with conventional (Western) vets, not against them.

For me, it is not Western or Eastern or whatever, for me the question is "what is in the best interest of the animal?".

Sometimes it is the conventional approach, sometimes the 'alternative', quite often it is a combination of both.

Dagmar
www.animalconnection.com.au

"'Open-mindedness' is a virtue in the social/personal realm. It's good to be open to other people's ways and habits on a personal level.

But scientifically, being open-minded is a flaw, if that means you accept new information uncritically. It is not only intellectual laziness, but it is UNETHICAL to accept new methods of diagnosing and treating disease without demanding full scientific scrutiny."

I REALLY like that. Can I steal it?? ;-) Truly, I think you hit the nail on the head and wish I could have said it so well.

I'd be honored if you used my statement. Only, it's not really mine, I just paraphrased my skeptical brethren.

SBM

I had a pet that got melanoma in the soft pallet.
We had just adopted him a couple of months when we found out.
The surgeon said the tumour was too large to remove and the only other option we could do was to try a new vaccine for this particular melanoma.

However it was 600.00 a shot and it might take a few of them. I did not have enough money and doing research told me the outcome most probably would not be favourable. I do think if I had the money I still would have tried.
At the time being new to having a pet we did not really have a regular vet so I looked online for a vet that would do a home visit so that when the dog’s life began to go downhill he could be euthanized in a place that he knew.
The vet I called told me I have to make an appointment first. He was a holistic vet. (No idea what that was at the time).
Long story short he suggested that it may be possible that the tumour could disappear using some kind of mushroom herb mixture. The cost would be around 600.00. He did not promise the dog would get better only that is was quite possible.
Anyway the tumour grew, when the tumour got real big and we knew the time was growing near he gave the dog some shots of red root? Or something like that. It actually caused the tumour to swell overnight and the dog suffocated.

I think if a faith healer came to my home and told me he could cure my dog I would have given him everything I had.
I think there can be a real danger especially when people are desperate. I am sure there are great holistic vets out there but as with anything that is not based in real science: opinions seem to be the basis for medical care.

After that experience I am not sure I would want medical care based on opinions rather than facts.

I am a physician for humans, and I agree with almost everything SkeptVet said. But like human clients who own pets, human patients will do what they want to do and what they personally see fit for their health, whether it is medically advised or not. So I try to take a gentle approach with them, to help them understand the points that SkeptVet outlined nicely. For patients who want to use herbs, I tell them that I can understand their concerns about side effects, but that herbs also have side effects that we do not understand well, and that even more concerning, is that they can have contaminants that can be deadly. For instance, it's not a particularly unusual story to see patients hospitalized with fulminant hepatic failure, and then on further history find out that they just starting some new herbal medicine. We go over side effects of established treatments, and I let the patients know the risks of letting their condition go potentially untreated by these herbs. Sometimes we agree to a short period of trying it their way, and then trying my recommended approach. For patients who don't want to go through diagnostic testing due to concerns about radiation and such, I also take a similar approach, discussing risk:benefit ratios. Where I work, we have a clinic staffed by board certified internists who are trained in accupuncture and other eastern techniques, and I send them patients with musculoskeletal pain or fibromyalgia or other functional disorders. That's what eastern medicine is good at. But these internist would be the first to say that the hypertensive patient needs antihypertensives and that the patient the rheumatoid arthritis needs DMARDs and steroids. It's basic common sense.

No, I don't think it makes you a bad veterinarian. I think nobody can do everything and do it well. I think it's good to specialize. As long as there is a recognition for other approaches and willingness to cooperate with vets who do specialize in alternative, all is great.

It is a closed mind and putting one's ego above the interest of the animal that is a crime.