On a daily basis, evidence-based practitioners around the world have to be poised for a battle against a magnitude of misinformation and false medical claims. From reiki to homeopathy, these alternative healing methods are surprising popular, and inevitably these concepts and beliefs filter into veterinary medicine. While pet owners are, of course, allowed autonomy in decision making for their pet’s health, the use of pseudoscience on our animals comes with considerable ethical considerations.
Take, for example, homeopathic remedies. There is sufficient body of evidence to supports the conclusion that homeopathy has no medicinal properties, and works no better than a placebo. There is no reliable evidence from research in humans that homeopathy is effective for treating health conditions, and such is the case within the veterinary field too: studies of a robust nature reported that homeopathy was not more effective than placebo. Overall, there is weak evidence in favour of homeopathic remedies, but as expected strong evidence for specific effects of conventional evidence-based interventions. This finding is compatible with the notion that the clinical effects of homoeopathy are placebo effects.
A common justification offered by homeopaths and their client’s is that pets cannot experience the ‘placebo effect’ so positive anecdotes must be attributed to the treatment, right?
The placebo effect is the improvement experienced when taking a placebo drug or treatment, which is not attributable to the properties of the treatment itself, and is often claimed to be due to the patient’s belief in that treatment. As our pets likely do not have a preconceived belief in the treatment, their owners will claim they cannot experience this psychological phenomenon – however, while pets may not have a preexisting bias towards treatments, there is a significant placebo effect seen on the owners, called the ‘caregiver placebo’.
The caregiver placebo essentially means that, as the owners have faith in a treatment, they see a notable benefit in their pets, even if the animal is not clinically any better. This effect works in combination with a number of other factors, such as behavioral changes the owner displays in giving their pet more attention after administering the medication, and the concept of ‘regression to the mean’ in chronic conditions.
Chronic conditions naturally wax and wane through good and bad periods. Understandably, owners seek treatment in a bad period, desperate to alleviate their pets’ suffering, so even when a treatment is ineffective, because the pets’ condition was at its lowest point, it naturally begins to improve. This improvement is then attributed to the treatment. Similarly, some conditions are naturally self-limiting, and will clear up on their own – when the condition resolves, owners attribute the improvement to whatever treatment they were giving at the time. Unfortunately, this often means that the patient unnecessarily suffered, without real support.
A study found that some advocates of alternative medicine even acknowledge that the placebo effect may play a role in its benefits, but believe it does not diminish the validity of the treatment. They claim that alternative medicine may provide health benefits through patient empowerment, by offering more choices to the public. But here is the crux of the matter: if owners believe their pet is better when it is not, we are prolonging unnecessary pain and suffering.
Harmless or Harmful?
In the UK, veterinary professionals who use homeopathy are obliged to use evidence based conventional medicine alongside it, to ensure patient health and welfare is not compromised.
In 2017, the Royal College of Veterinary Surgeons issued a position statement on the use of homeopathy, which stated:
Homeopathy exists without a recognised body of evidence for its use. Furthermore, it is not based on sound scientific principles. In order to protect animal welfare, we regard such treatments as being complementary rather than alternative to treatments for which there is a recognised evidence base or which are based in sound scientific principles. It is vital to protect the welfare of animals committed to the care of the veterinary profession and the public’s confidence in the profession that any treatments not underpinned by a recognised evidence base or sound scientific principles do not delay or replace those that do.
Given that in the UK, veterinary surgeons can only dispense complementary therapy, such as homeopathy, if it is given in conjunction with conventional medicine, it would be easy to believe that such treatments are a benign option that owners can choose should they wish. However, the tolerance of homeopathy supports notions such as a ‘natural is best’ fallacy, which can lead to distrust of conventional medicine and those professionals working in an evidence-based manner. In turn, this means delaying seeking effective medication and treatment, and prolonged suffering for the animal, as well as inappropriately directing finances to non-evidence-based therapies.
Of course, owners are at perfect liberty to use their finances as they see fit, however a recent report showed many owners are worried about veterinary costs. It is possible that the National Health Service in the UK has left many people ignorant as to the expense involved in health care. It is noteworthy that veterinary professionals are often subject to extensive abuse about cost of veterinary services, yet the practitioners of alternative medicine also charge, quite substantially, for their service. If treatment and finances are directed towards non-evidence-based therapies such as homeopathy this could mean that effective treatment is delayed, leaving the patient to deteriorate further, which in turns means more care and more expense. Sadly, in some cases, the owner may have spent precious finances on treatment that does not work, leaving little left for evidence-based treatment options.
This raises an interesting question: if the RCVS state that homeopathy should only be used alongside conventional treatment, could that still delay treatment? In human medicine, we know that those who have used alternative medicine instead of conventional treatment are slightly less likely to have a primary care provider, or to have had a preventive care in the past year. A study found that the use of ‘alternative’ treatment was associated with the delay of seeking cancer treatment, and decreased survival.
Often human health tends filter into veterinary medicine, in this case although in the UK veterinary professionals are obliged to only ever dispense homeopathy when used alongside conventional treatment, this does not mitigate the implications associated with the belief system in homeopathy. The ‘natural is best’ fallacy, misinformation, and fear mongering amplify medical anxiety and the distrust of conventional treatment, which can lead to evidence-based treatment being delayed or declined. In an informal poll ran on Veterinary Voices UK, 87% of participants had experienced issues in the use of non-evidence-based therapies that could have impacted animal health and welfare.
Through direct and indirect means, the use of non-evidence-based complementary therapies, such as homeopathy, may have negative implications on animal health and welfare. Naïve owners are persuaded by the proponents of these therapies, their evangelical confidence, and their illusion of upmost care and protection of pets. Practitioners routinely use emotive language, which can terrify unsuspecting owners and overstate the supposed dangers of conventional treatments. Once owners have been persuaded to put their faith in alternative treatments, it is extremely hard to change their mind. As such it is difficult, and demoralising, to attempt to have constructive conversations.
All veterinary professionals want is for animals to be happy and healthy. Medicine isn’t a con or conspiracy theory aimed at making pets sicker, it’s about working with the evidence we have, so that pets have the best chance at a positive outcome.