I recently read an article by a human oncologist, wherein she made a profound statement that nicely encapsulated my feelings about the inherent conflict surrounding public protection and the practice of alternative medicine. She said that “…a doctor can face reprimand for inadvertent error but an alternative practitioner can get away with intentional harm.”
That line resonated with me and stuck in my head for several days. We face the same situation in veterinary medicine – a veterinarian who makes an inadvertent error (even a minor one) can be fined, receive a reprimand, be ordered to take continuing education, or even be suspended, while another veterinarian can prescribe completely unproven or frankly “quacky” treatments and in many cases not be at all discommoded.
I take issue with the regulation of alternative modalities where I practice. Despite a dearth of evidence for many alternative “therapies”, their use is not restricted, or (more accurately) the existing restrictions are not adequately enforced. This has turned western Canada into the Wild West as far as alternative medicine – anything goes, good evidence of efficacy isn’t required, and science is out the door.
It feels like the regulatory boards “regulate” alternative modalities because they don’t want non-veterinarians treating animals. I can see why – without veterinary oversight of animal care there would be a lot of inadvertent abuse and neglect. Veterinarians are the best resource animals have to live long, happy lives. But it also seems that the boards are incapable or unwilling to properly regulate alternative modalities.
What they say
All of the western provinces have published statements regarding alternative medicine. BC put out a position paper in 2005 that is probably the most strongly worded regarding alternative practice.
In that paper, the BC regulators clearly say that they need to protect the public from being misled by veterinarians who may overstate the evidence for (or lie about) alternative treatments.
“The primary duty of the BCVMA is to protect the public, including from misleading or misinformation disseminated by veterinarians…It is imperative that the veterinarian strives to provide clear, objective and verifiable information.” (emphasis added)
The ABVMA and SVMA have similar statements (Alberta and BC appear to have shared source material for their position statements).
All of the provinces copped out when it came to condemnation or approval of specific therapies (or taking any position at all). From BC and Alberta:
“A scientific evaluation of the merits of each complementary and alternative veterinary modality by the (regulatory board) prior to its implementation is impractical.”
Yes, an evaluation of each and every modality may be impractical. But we know that some modalities claim mechanisms that defy very basic scientific principles and cannot work (*cough*energy medicine*cough*), and that for some modalities this scientific evaluation has already been done. Homeopathy is an excellent example of a modality where recent in-depth analyses of published studies failed to find any evidence for efficacy (beyond placebo). [Mini rant – Why are veterinarian allowed to use homeopathy? Why don’t we speak out, say the emperor has no clothes, and stop looking like idiots as a profession?]
Both BC and Alberta VMAs state:
“A complementary and alternative modality must not be offered to the exclusion of a conventional therapy, which has known, demonstrable benefit to the patient.”
There are very few diseases that have no conventional therapies that have demonstrable benefits. The application of alternatives as a sole therapeutic option should therefore happen only rarely. And yet we have many practices in western Canada that offer only alternative therapies, to the exclusion of all others, in contravention of their own associations’ rules.
Mere lip service?
The most important test of regulations is what happens when the regulations are broken. There is no evidence that any provincial association takes their own bylaws and position statements about alternative medicine seriously. For all of the dire warnings and explanations, it appears that the regulators have no teeth. Or have the teeth of a fat 10 year old Yorkie.
BC has a new Veterinary Act that went into place in 2010 and has the most transparent disciplinary process that I could find. They post their complaint decisions online, and there are a lot of them. (Either pet owners in BC are a very litigious bunch or our Alberta and Saskatchewan VMAs simply don’t publish any of their complaint results. I think it’s probably the latter, to my disappointment. Transparency is important. If you live here in Alberta or Saskatchewan or anywhere in Canada, really, you should be lobbying your provincial regulators to make complaint results public. We vets will be very uncomfortable with it at first, but the public have a right to know that self-regulating professions really are regulating themselves.)
All three provinces claim that “peer review” is the main method of dealing with complaints. There is only one BC complaint on that long page that deals with an alternative medicine case, and it does appear that BC is upholding their stated course of action when a case comes to their attention. However, it’s obvious from the lack of other disciplinary proceedings against alternative practitioners that the process is entirely consumer complaint driven as opposed to regulators taking proactive steps to protect the public.
Why does peer review fail when it come to alternative medicine? Let’s say that someone in Saskatchewan complains about the competence of an alternative practitioner who recommended and performed and alternative therapy, like homeopathy, or Reiki, or traditional Chinese medicine. The regulatory response is that “the peer review may consult with veterinary colleagues who are knowledgeable in that particular modality”.
This is senseless. In BC, Alberta and Saskatchewan if you treat an animal with X, the provincial association consults other X users to see whether you used X in a manner that other X practitioners would use. If so, you’re all good. Because X is complicated, and we aren’t, for pity’s sake, about to use things like science or evidence or common sense to determine whether X is legitimate in the first place.
Now, people would object if, instead of X, I had used “chiropractic manipulation” in the paragraph above. Or acupuncture. Despite little objective evidence of their efficacy, we like these modalities and they have the veneer of science. But what if we get out to modalities with even more tenuous evidence behind them, like cold laser therapy? Or modalities with NO scientific evidence of efficacy, like NAET, or homeopathy, or magic?
“If you treat an animal with magic, the provincial association consults other magic users to see whether you used magic in a manner that other… wizard vets would use. If so, you’re all good. Because magic is complicated, and the review board members are just muggles.”
Sounds ridiculous, doesn’t it? We all know there’s no such thing as magic and we’d fully support any actions taken against a veterinarian who seriously claimed that magic would cure cancer, or even cure warts. There is no more evidence for some of the alternative therapies that there is for magic. Why do regulators of veterinary medicine (or human medicine, for that matter) fail to protect the public from being misled by practitioners who use the equivalent of magic and promise results?