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Evidence-Based Medicine - What’s the Truth?
In any discussion of holistic, integrative medicine, it’s not unusual to hear the term "evidence-based" medicine thrown around. Usually, this term is used by opponents of a holistic/ integrative approach to health care. One method the fans of a strictly conventional approach use to try to shut down any rational discussion of using holistic therapies is to ask, "Where’s the evidence (proof) these therapies work?"
One of my goals is to start an integrative medicine course at my alma mater, for Texas A&M University College of Veterinary Medicine. A friend of mine, a proponent of integrative medicine, had the opportunity to discuss my proposal with the dean of the veterinary school. His response was that while some of the students and a few faculty members had shown an interest in integrative medicine, most of the faculty was opposed to the idea. He stated that they were a conservative school and only wanted to teach "evidence-based" medicine.
The astounding thing about his response is that there is a large amount of evidence behind the therapies we use in integrative medicine. For example, there are many years of research showing the benefits of joint supplements such as glucosamine for people and pets with arthritis. Not only do the studies show the positive benefits that can be achieved when the proper joint supplements are used correctly, but we have cellular evidence showing exactly how the supplements work in the body.
Omega-3 fatty acids have been recommended for use in pets for over 30 years. Originally proposed to help pets with allergic skin disease, we now know from the evidence obtained through research exactly how omega-3 fatty acids work, and that they bring positive benefits to patients with a number of diseases, including heart disease, joint disease, kidney disease, and even cancer.
I’ve had the pleasure of writing 12 books on the topic of integrative medicine for pets, and have contributed to countless other books and articles on the topic. These books came about after carefully researching the evidence-based medicine that supports the therapies I described. I regularly read textbooks and medical journals in both the human and veterinary medical fields describing evidence-based natural therapies that can be used in place of or in conjunction with conventional medical therapies.
For a dean of a prestigious veterinary school to state that there is no evidence for integrative medicine is illogical and ignores the large amount of proof that exists for the therapies we use every day. If we are going to take the "high and mighty" approach that we will only teach or use therapies based on "evidence," then to be fair we must be consistent in our approach.
There are many conventional therapies that have been used in both human and veterinary medicine before a full understanding of how they worked was known. Even today, certain medications are rushed to market an attempt to help severely ill patients before a full body of "evidence" is obtained.
For those whose veterinarians are opposed to using an integrative approach to health care, citing that they only use "evidence-based" medicine, I would suggest you pose the following question to them:
"Where is the "evidence-based" medicine that
supports the common practice of annual vaccination?"
Of course if you ask your veterinarian this, you may upset him or her so much that you’ll soon be looking for a new veterinarian (which is not necessarily a bad thing if he or she still practices the outdated suggestion that pets need annual vaccinations!)
The easy answer to this important question is that there is no "evidence-based" medicine to support the worn out and dangerous practice of annual vaccination for pets. There is no research proving that pets require annual vaccination for every infectious disease.
Did you ever stop to wander the following: if annual vaccinations are so important for dogs and cats, why we don’t vaccinate people every year against infectious diseases? Shouldn’t we too be protected annually against infectious diseases?
Well there are really two reasons we people do not receive annual vaccinations. The first is that most vaccines produce long-lasting immunity in people (and in pets!) Annual vaccination is not necessary, and would actually constitute malpractice in human medical practices. Based upon years of research we know the approximate duration of immunity each vaccine will produce in a given human patient.
The second reason for not administering vaccinations to people on an annual basis is to prevent serious and possibly fatal side effects. These can include serum sickness (a severe allergic reaction to the vaccine components,) immune diseases of the blood and other organs, and even cancers.
Knowing this, it is tempting to ask ourselves why we vaccinate pets every year.
Research done over the last 10 years shows that the high quality vaccines we use every day in practice produce long-lasting immunity in pets, similar to what is found in people. At this point we don’t know the maximum duration of immunity for each vaccine. Studies have shown that some of our vaccines can produce immunity for five or ten years, and possibly even for the life of the pet.
As is true with people, we see a number of diseases in pets who are vaccinated too frequently.
While current recommendations from veterinary vaccine experts recommend vaccinations every three years, integrative doctors, including me, recommend only vaccinating healthy pets based upon the results of inexpensive blood titer tests.
The other question that’s tempting to ask ourselves is what constitutes "evidence?" How do we know that a therapy works or doesn’t work? How do doctors gather evidence?
Whether we’re talking about a drug or natural therapy, evidence is only obtained by using the therapy in patients. We know for example that ibuprofen works well in people to control headaches, inflammation, and mild pain because millions of people have used many doses of the medication. We know that the NSAID Metacam works well in dogs and cats to minimize inflammation and pain seen with musculoskeletal problems and following surgical procedures. Likewise we know the nutritional supplement choline works very well to help prevent and treat cognitive disorder in pets, and glucosamine, chondroitin, and hyaluronic acid are great therapies to relieve arthritis pain. We have evidence of the effectiveness of these therapies because someone thought they might work, then the therapies were tried in a small number of patients and showed effectiveness and safety, and finally many doses were used which confirmed the initial findings of safety and effectiveness.
So when a conventional doctor with a bias against integrative medicine states that he only supports "evidence-based" medicine, he’s not being honest or fair. He only supports conventional medicine, even when (in the case of annual vaccinations for dogs and cats for example) there is evidence-based medicine showing that this conventional practice is no longer needed!
Finally, keep in mind that medicine is part "art" as well as part "science." While it’s great to have a lot of "science" behind what we do, integrative medicine appreciates the "art" of medicine. There is no one "cookie cutter" approach to treating every patient. Experience obtained by treating large numbers of patients, and being open to trying whatever therapy might help the patient, constitute the "art" of medicine. So often the "art" is what is missing from the strictly conventional approach. Most of what I and my holistic colleagues do is try to find the best therapy for each patient based upon historical and examination data. While I have science to back up everything I do, it’s my application of the science (which is the "art" of medicine,) which determines the outcome of each case.
"Evidence-based" medicine is important, but integrative medicine is "evidence-based" and should be accepted as freely as "evidence-based" conventional medicine.
Keep that in mind the next time someone tries to convince you that only "proven" (conventional) therapies can help you or your pet!
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