Beach Metro News
By Dr. Nigel Skinner • July 24, 2012 • Print This Article
Almost every day I encounter pet owners who make it clear that for any given problem they would prefer a ‘natural’ remedy over anything that could be considered a ‘drug’. There has been a definite shift over the past few decades in this direction, fuelled in no small part by the ease with which knowledge is now spread throughout the population. People understand that medicine is evolving and therefore it is flawed, the doctor can be wrong, and sometimes the best intentions do more harm than good.
Unfortunately this has created a culture where many people feel they must choose sides; that your thinking must be aligned one way or the other toward a single ‘type’ of medicine: traditional/ western vs alternative/natural.
I think that we are not doing ourselves, or in the case of veterinary medicine, our pets any favours at all by looking at our overall health care this way.
By the typical definition I would say I was trained and have experience in ‘traditional or western medicine’ but in truth I prefer to say I practise ‘evidence based medicine’. This distinction may not sound significant but when we keep this simple definition in mind it removes any notion that there are disparate schools of heath care and that we must choose which side we are on.
Evidence based medicine in simple terms means that when we recommend a diagnostic test or treatment we do it because there is sufficient verifiable, established evidence that the test or treatment is appropriate for the situation. Typically this means that we know that it is either completely safe or if it carries any risks, we understand those risks, how to minimize them and are able to say with a good degree of confidence any risk is outweighed by the expected benefit. Which brings us to the other criteria; that we have evidence that a benefit exists. This means that the treatment has to be evaluated in a very specific way to eliminate, as much as possible, the chance that any benefit seen could simply have been due to coincidence.
That’s not to say that when there is no published evidence for a treatment that therefore it does not work. That is an invalid assumption. In many cases the evidence does not exist simply because no researcher has gone through the process of establishing it. More often than not, this is due to cost. It is typically a very involved, lengthy and expensive process to establish the safety and efficacy of a treatment. That money has to come from somewhere and with research dollars already very hard to come by, establishing clinical evidence for something that has been used for years, or something that cannot be patented or expected to eventually be profitable for the research funder, is usually not a priority. It’s important to remember there is a difference between “that doesn’t work” and “there’s currently no evidence that that works.”
For example, if someone told me that they had a friend who met someone at the dog park whose sister had a dog with lymphoma and they treated him with lavender and tea tree oil drops in his food and he lived another five happy years, I’d probably be skeptical and wonder if the dog truly had lymphoma at all. If, however, a controlled and critiqued study was done on 100 dogs with confirmed lymphoma using this treatment and there was a statistically significant improvement in the patients receiving this concoction, I would be the first to recommend lavender and tea tree oil for every dog I diagnosed this disease in. I wouldn’t care at all that it was not within my ‘school of thought’. I’m quite certain that most practitioners both in the veterinary and human world would feel the same way.
I was asked recently whether a patient suffering with the early stages of arthritis might benefit from willow bark. I had to admit I was not sure, but would investigate. I reviewed arthritis and willow bark in a text I keep handy on alternative therapies. It spoke of earth elements, wind and dampness causing stagnation of circulation leading to pain and swelling. These notions are from traditional Chinese medicine, and having received my education in a western veterinary college were quite alien to me. It might have been easy to stop there, write it off as nonsense and tell the pet owner it won’t help. A little more reading reveals that willow bark contains salicylic acid, the same compound we know as aspirin. So right away I can align this natural therapy with something in ‘traditional medicine’ that is very familiar. There’s no shortage of research on the mechanism of action of aspirin, so I can immediately get my head around understanding why willow bark does help with inflammation. We can also tell right away that despite being ‘natural’ there may be the same side effects we associate with aspirin in dogs and most importantly we know not to combine this herbal therapy with other prescription medications in the same class, as those side effects will be cumulative. Without doubt, many other herbal and homeopathic remedies have actions that either are, or could be, described and proven in a clinical and scientific way and as such understood by all health care providers.
Health care in general, veterinary and human, is evolving and our knowledge is expanding at a remarkable rate. What this should remind us is that there is a tremendous amount that we simply do not yet know. Almost without doubt some of our common practices today will be frowned upon in years to come as new knowledge is added to the fraction we currently have. For now the best we can do is work wisely within the confines of what we know, accepting that what we know will change in time.
So whether it is concerning your own or your pet’s health care, don’t think that you have to approach any given problem in one single way and seeking treatment with traditional or with alternative medicine has to be one or the other. The truth is there are definite benefits and flaws in both, so rather than asking “am I going to treat this with drugs or with a natural therapy?”, understand that there can and often will be overlap. Take the best of both worlds by keeping an open mind and asking “how do we know this is safe and how do we know it works?”