StemCell Therapy

People see the changes they expect in their pets, leading them to misattribute illness, good health, improvements, and declines.

Dr. Brennen McKenzie is a companion animal veterinarian working in California, the writer behind the SkeptVet blog, and the author of the recently published book, Placebos for Pets? The Truth About Alternative Medicine in Animals. He also is a columnist for Veterinary Practice News and past president of the Evidence-Based Veterinary Medicine Association. He wrote a 2014 JAVMA commentary on cognitive bias in clinical decisions (J Am Vet Med Assoc 2014:244;271-276).

In his book, Dr. McKenzie teaches how to evaluate the theories, methods, evidence, and safety records for myriad complementary or alternative therapies. The following interview has been edited for length and clarity.

A. I initially was thinking of it as a resource for pet owners, and I tried to write the book in language that is accessible to the general public. So, Im hoping that it will be an introduction to the general ideas about how we evaluate medical therapies for pets, whats the appropriate way to do that, whats the role of science in helping us to evaluate these thingsand also an appraisal of some of the more common alternative medical approaches that pet owners are likely to encounter. However, I also wanted it to be useful to veterinary professionals. All of the things that I talk about have extensive academic references available so that they can dig deeper if they want.

A. Its a fundamental feature of human cognition, and this is one thing I think all veterinarians should have some familiarity withthe history and philosophy of science and cognitive psychology. We all reason in ways that are kind of built into our brains.

I give a patient a medication, and a week later, that patients clinical symptoms resolve. I see a causal connection there and assume that the medication is responsible for the change. What we know from science is that its a lot more complicated than that. Were often doing multiple things at once. Diseases have a natural history where their symptoms wax and wane and can just resolve spontaneously. We may have the wrong diagnosis to begin with, and so when things dont go the way we expect, its not always because of what we did but because we were wrong about our assumptions.

Its very difficult for any of us, whether were veterinarians or not scientifically trained, to ignore our personal experience. And if a study comes out saying something that Ive been doing for 10 years and been selling to clients doesnt work, its difficult psychologically and cognitively for me to accept that my assessment is wrong and that Ive been doing the wrong thing.

A. Its complicated. One of the primary questions in science education today is, How do you change peoples minds about things? And were facing a crisis in terms of vaccine hesitancy (see story).

As a clinician seeing patients, I have a few key things that I try to focus on when I want to challenge somebodys perception. The first is I have to acknowledge that I understand their perception and validate their experiences and their reasoning.

If you begin by telling people that theyre ignorant or stupid, they wont listen to you. They may have perfectly rational reasons for a mistaken belief. So you begin by saying, I understand why you feel that this is a useful approach or why you feel that this therapy has been helpful to you. And then you introduce some potential reasons to doubt that.

I often talk about other cases in science where weve given up on therapies that clearly dont work anymore. Bloodletting is a great example where we believed in things for long periods of time and found them not to be true.

I also try to say, OK, lets look at this in terms of risk and benefit. Glucosamine is a widespread therapy for which theres very little evidence of efficacy, and yet, everyones using it. I say to people, Here are the reasons why I dont think it probably works. I also think that the risks are quite low, so I dont feel like its imperative that you give up that.

If you meet people halfway and work with their beliefs and their goals, I think theyre more likely to listen to you. Over time, you build a relationship with clients, and they come to trust you, and I think that gives you more credibility to tackle larger and more challenging beliefs.

It also makes a difference where that belief fits in their life. Im not going to talk to a client whos a chiropractor and try to convince them that chiropractic is not a valid therapy because thats embedded in their entire life, and thats not going to be a useful or successful interaction.

A. Almost certainly not, no. I think most people dont understand the theories behind the drugs that I give them, either. Most people are not interested in the deep background of medical therapies. What they hear are claims by practitioners of benefits, usually justified in terms of, Ive been doing this for 20 years, and it sure looks to me like it works. Anecdotal claims tend to be the easiest to offer and the most psychologically compelling, even though theyre the least reliable.

There are certainly some people who have a general worldview that is skeptical of science and technology and the pharmaceutical industry, which has certainly earned a great deal of skepticism. And I think that alternative medicine fits into that worldview. I think also that conventional medicine, particularly for humans, has a lot of serious problems in terms of how we communicate with people, how we manage their lives and their needs. Weve become very siloed and segmented into subspecialties and very technologically focused. I think there are a lot of things wrong with how we offer health care to people, and the environments and conversations that alternative practitioners often have with people address a lot of those concerns and those problems. I do think that alternative medicine fits into peoples lives in an ideological and philosophical way.

A. I do offer some fairly simple guidelines in the book. One is that no single study is ever definitive because its impossible to completely eliminate bias. If theres only one study, you should still be a bit skeptical. Larger studies are better than smaller studies. Any study that does not effectively have a placebo arm and doesnt hide from both the owners of the pets and also the investigators or veterinarians which therapy each pet is getting is probably going to be biased and not reliable. So, there are some very simple rules that you can apply.

I think, honestly, the onus is on veterinarians to be better at understanding how to appraise a clinical trial and then to talk to owners. Even in the absence of large-scale, definitive, high-quality evidence, I do think we can look at these therapies and the reasoning behind them and the evidence for them and make sound, honest recommendations one way or anotherthat dont just rely on anecdotes.

Theres a method that I try to teach in the book for approaching things, so even if there are things that I dont cover in the book, I hope that itll be useful to people in terms of finding a structured, reliable way to approach new things.

As a veterinarian, Im hearing about new supplements and new therapies all the time, and many of them dont have a lot of research evidence. But I dont think we have to say to our clients, I dont know, theres nothing I can do, take your best guess. I think we can use a systematic, science-based approach to help guide and counsel our patients.

Read more from the original source:
Veterinarian works to reduce caregiver placebo effect | American Veterinary Medical Association - American Veterinary Medical Association

This entry was posted on February 12, 2020 at 11:47 pm and is filed under Veterinary Medicine. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed. |