Medical care and therapy of patients, both human and animal, can be quite involved and require a number of different medications and therapeutic modalities. At Somers Animal Hospital we primarily practice conventional, sometimes referred to as Western or allopathic, medicine. Alternative and complimentary medicine uses philosophies and treatments that differ from conventional medicine. Many of the treatments are based on Asian, especially Chinese, philosophies. alternative/complementary treatments include things like acupuncture, chiropractic care, massage therapy, therapeutic laser therapy, herbal supplements and homeopathy. Some of these therapies have become fairly mainstream. We do utilize some of these therapies to complement the traditional medicine we practice. Some of these complimentary treatments have sound scientific basis and some do not and this will be a discussion of these aspects.
The trend in traditional medical and surgical care is to use evidence-based medicine to decide whether a diagnostic procedure or treatment is worthwhile. The evidence comes in different levels- the lowest levels of evidence are based on clinical experience, followed by clinical and therapeutic trials. The most significant evidence is based on double blind clinical trials. This means neither the subjects taking the medications or treatments nor the people administering them know if they are getting an actual medication or a placebo. It is not until the trials are finished and all the information is collated is it known if the treatment is effective and better than the placebo effect. All clinical trials have a placebo effect. Even trials using animals have placebo effects- not necessarily in the animals but in the humans caring for them. If you are expecting something to work, it may have some type of positive effect. This is mostly psychological, but still can have noticeable physical effects. Most, but not all , of the drugs and therapies we use have gone through some level of clinical trials. So we have fairly good evidence for the efficacy and safety. Responses and possible side effects are fairly predictable. Drugs and pharmaceuticals we use are all controlled by the FDA. They must adhere to strict definitions of purity, efficacy and safety. The chemical make-up and dosage must be what is listed on the label. Any medication can have adverse side effects and individual patients respond differently.
What about alternative and complimentary therapies? Some have been well studied and have good scientific evidence for their use and efficacy. Acupuncture has become an almost mainstream therapy over the last 20-30 years, even though it has been part of Chinese medicine for hundreds of years. Scientists have studied how it works on the nervous system. One of the mechanisms of effect is that the needles placed in specific parts of the body cause release of endorphins- the body’s own morphine-like (opioid) pain relievers. The pain relief effects can be blocked by opioid blockers. This indicates a real, not a placebo, effect. Therapeutic (cold ) laser therapy, which we have been using for the last 2 years, has many studies showing the physiological effects of the laser on blood flow, stimulation of anti-inflammatory substances in the body and other effects. It seems useful in arthritis and many other painful conditions.
Other alternative therapies have far less evidence and successful responses are often based on anecdotal reports. This is basically the statement by a patient or pet owner about the responses they are getting. There is often a major placebo effect involved. There are very few controlled clinical trials for any of these modalities. In addition, herbal supplements, nutritional supplements and nutraceuticals (nutritional supplements used for therapeutic purposes) are not controlled by the FDA. Therefore you cannot be guaranteed of purity, safety and efficacy. When independent organizations randomly test these supplements they find levels of things listed on the label vary very widely. They also find many contaminating substances. This is especially a problem with herbal remedies from China. This is why they must put a statement on the label to the effect that claims for efficacy have not been scientifically studied.
That being said, we know that a substantial proportion of standard pharmaceuticals are derived from natural substances. Antibiotics from molds and fungi; digitalis from the foxglove plant; taxol, a chemotherapy agent, from the pacific yew tree are all examples. The difference is that the active ingredients have been isolated, purified and standardized. Natural and herbal supplements are extracted from their natural sources but not necessarily purified and standardized. This can and should be a concern. There are supplement companies that do adhere to strict manufacturing guidelines and many others do not so it can be difficult to know what you are actually getting.
There is also the feeling that many people have that because it is natural or herbal it is non-toxic and safer than traditional pharmaceuticals. This is not necessarily true. Many natural substances are highly toxic. These substances evolved in plants to inhibit consumption by insects and other creatures and in animals to protect against predators and can be quite toxic. Several herbal supplements have been removed from the market because they caused severe side effects, including liver failure.
We do use a fair number of nutraceuticals and herbally derived supplements. For example, Denamarin contains silymarin, a chemical derived form the milk thistle plant, that has been shown to have beneficial effects on inflammation of the liver. Glycoflex, an anti-arthritic supplement, has many ingredients but one is derived from the shells of the New Zealand green-lipped muscle. We try to obtain our supplements from very reputable companies with known histories of accurate preparation of their supplements. Most adhere to and have labels for the NASC (National Animal Supplement Council) that has strict standards for purity and manufacturing standards. They also regularly inspect the facilities. So we feel confident that the products we dispense are good ones.
The last issue is homeopathy. This was developed about 150 years ago by a physician who had a philosophy that like cures like. So he made extremely dilute solutions of a substance that in higher doses would cause significant symptoms. The problem with homeopathy is that there is absolutely no science behind the philosophy and virtually no studies on efficacy. When homeopathic substances are tested, they are diluted so much that often no evidence of the supposed active ingredient can be measured. Often it is just water or alcohol that the substances are diluted in. This is one alternative therapy that we cannot recommend.
A couple of last points. People often take these supplements on their own and do not tell their doctor, or vet if they are giving them to their pet. It is very important to let us or your physician know as there are many adverse reactions between these supplements and conventional drugs, and please listen to your doctor or vet about proper treatment with known and tested medications. Often a treatable disease can progress when these supplements are used instead of conventional and tested treatments. Many of these things can be used along with, but not instead of, more proven therapies.
Martin Randell, DVM, DACVIM