There are about 100,000 veterinarians in the US. Speaking generally, we are conscientious, hard-working, animal-loving, and pretty likely to ruin a dinner conversation by bringing up the common parasites of whatever everyone is about to eat. We love science. If you want to slog through the years of study and training required to become a vet, you have to have a knack for and a love of science. You have to take chemistry five times (general, organic, biochem, organic, physiologic, okay I failed o-chem the first time). Every single person that has successfully become a veterinarian has had a solid understanding of a whole heck of a lot of science.
But we aren’t scientists per se. We like the fun gross stuff but we don’t necessarily think scientifically all the time. We usually aren’t running experiments, dispassionately reviewing evidence, and trying to prove ourselves wrong. Maybe we’re like airline pilots with a detailed knowledge of machinery and weather conditions, but who aren’t necessarily aeronautical engineers. Don’t get me wrong, it’s not that you can’t be both (and it’s often of great value), but most of the time we just don’t think in a purely scientific sense. Because it’s hard to do so. We have limited time, information, and resources, and we’ve got to get stuff done. We rely on subjective experience a lot. We’ll speculate and guess. We get hunches like a gothic cathedral bell tower. Often, we’re open to anything if it gets Mrs. Angry-Chihuahua-Owner off my case so I can go sedate this hissing cat for x-rays!!
We certainly haven’t scientifically assessed a lot of what we do in veterinary medicine. And because we have to go off of extrapolations and our best guesses, sometimes we’re open to ideas that might even be scientifically implausible. Specifically, I’ve always thought that complementary and alternative medicine (CAM) was fairly prevalent. You’re reading an SBM article, so your disinclination toward alternative medicine is probably the same as mine, but amongst my veterinary colleagues I always feel a bit more skeptical than most. Which is why I got curious when I saw a recent poll asking exactly this question: “What do veterinarians think about complementary and alternative medicine?”
The survey was part of a project of weekly polls conducted by the Veterinary Information Network (VIN), a wonderful online forum and resource for veterinarians. They ask all sorts of clinically and topically relevant questions in these polls, and they are a great snapshot of current veterinary thinking. This poll asked about “beliefs and practices” in CAM modalities. The following were listed: homeopathy, acupuncture, Reiki, chiropractic, and “other”. Veterinarians responded saying whether or not they believed the modality was effective for certain conditions, and whether or not they personally practiced it or referred patients for it (which is probably a better indicator of how much they truly believe it works).
Overall, a majority of veterinarians believed in the effectiveness of at least one of the modalities, but significantly fewer either personally practiced or referred for them. Acupuncture had the highest belief, at 63%, followed by chiropractic at 33% and 16% for homeopathy. About one out of every three veterinarians personally practiced acupuncture or referred patients for it, followed by 14% for chiropractic and 4% for homeopathy. These numbers can be hard to contextualize, but just for a fun comparison, about 36% of Americans have personally felt the presence of a ghost and 13% believe in vampires.
One could say that homeopathy is about as plausible as vampirism (well, actually porphyria makes me double-think that), so maybe these numbers aren’t too surprising. But unlike the ghost poll, the veterinarian survey asked a question to gauge skepticism, “none of these options are supported by enough scientific evidence for me to include them in my practice”. Only about 25% of veterinarians were smarmy, condescending buzzkills—errr… agreed. That is, only a quarter of veterinarians feel that these practices are so unproven as to not be worth using. Far less than are already convinced acupuncture is beneficial. And this isn’t the place to necessarily discuss the efficacy of acupuncture, but I think an impartial judge would probably have to conclude that it’s far from “proven” (see, for instance, here).
This is just a survey. It’s a small sample of veterinarians who happen to be willing to respond to a questionnaire in an online forum. If you asked the questions differently you might get different numbers. But the weird thing is these percentages seem completely realistic to me, and I’ve worked in a lot of different veterinary clinics. If anything, I would have said the quarter of veterinarians who didn’t feel there was enough evidence for those modalities was too high!
OK, what about other people that wear scrubs?
Is CAM belief more prevalent in veterinarians than physicians? Nurses? Dentists? Chiropracto—errr, nevermind? You can’t really do an exact comparison with other healthcare professionals because the exact same questions haven’t been asked. Plus, there’s a bunch of different CAM modalities and “indications” so it’s like trying to figure out how people that drive things feel about sports. Still, there is a fair amount of information on how healthcare practitioners feel toward CAM. For example, this older study found rates of support amongst physicians of 51% for acupuncture, 53% for chiropractic, and 26% for homeopathy. Other studies have found some support for CAM among healthcare professionals and students, although often there is some variation in this support. In a review that included responses by physicians, PA’s, NP’s, RN’s, social workers, dietitians, social workers, dentists and mental health professionals, a consistent finding was that physicians had a more negative view of CAM than other professionals.
As this post was in editorial purgatory, David Gorski wrote a post describing this study, in which physicians were surveyed about their use of CAM for patients. The rates were about 27% for chiropractic, 22% for acupuncture, and around 13% for homeopathy.
Conclusion: CAM is common, skepticism is not so much in vet med
Depending on your background, these percentages might either shock you, amuse you, bore you, or affirm your suspicion that most veterinarians (if not most healthcare professionals) endorse some form of CAM. You might also be a bit surprised that such a low percentage of us are skeptical of CAM. But that, for better or worse, is where we are in veterinary medicine right now. We are far from being a truly science-based field. We’re the ultimate general practitioners and we don’t always have the time or incentives to dig through scientific literature on a regular basis. There is a small group of people (The Skeptvet, The Royal College of Veterinary Surgeons, The Evidence Based Veterinary Medical Association, and The Centre for Evidence-based Veterinary Medicine) who are pushing to make this type of approach a priority, but it is not as widespread as some of us might hope.
This is a point worth discussing, because the body of scientific research in veterinary medicine is so sparse compared to human medicine. If we truly take a skeptical approach to our practices, we have to admit that maybe most of what we do is not proven. Rather, it’s maybe extrapolated from human medicine, maybe based on plausibility, or maybe just made up on the fly. We could and should investigate these things scientifically and overturn entrenched “mainstream” practices when they turn out to be harmful (the more recent move to reduce antibiotic use in cases of asymptomatic bacteriuria is a good example, although still far from a widespread practice). Let’s flip on the light of science-based medicine and let the incorrect ideas scatter.
All of this doesn’t mean veterinarians are backwards or anti-science. Believing in the benefits of acupuncture or using best-guess antibiotics when unnecessary doesn’t negate all clinical skills and scientific knowledge. You can also believe in vampires and be an excellent vet (especially for bats). I think it means that we’re busy, under-resourced, and susceptible to bias. Keeping abreast of the latest science is hard! I do think these numbers highlight the potential we have to become a more scientific profession though. In my opinion, evidence-based practice is to everyone’s advantage. If veterinarians think more critically, we’ll be better serving our patients and clients. This means abandoning disproven therapies while at the same time accepting proven practices even if they can’t be explained at every level. And it may be tempting to scoff at us in the animal medical field as gullible witch doctors, just remember that the numbers in human healthcare professions are hardly better. I take a little comfort in knowing that at least our patients don’t believe in magic.