Educational Articles
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Perspectives on integrative veterinary medicine (Ron Carsten, DVM, PhD, CVA, CCRT) Integrative veterinary medicine is considered to be an effective combination of conventional veterinary therapies and alternative, complementary or holistic approaches. The term, integrative medicine, emerged in the 1990’s as a way to describe the evolving trend of combining therapeutic modalities. Integrative veterinary medicine as a term more precisely describes the current mixing of holistic and conventional approaches than the use of the terms complementary or alternative by themselves. Complementary implies an inferiority of effectiveness and that these approaches only play a supporting role in patient treatment. The early use of “complementary” was a logical expression of a growing interest in therapies like acupuncture, veterinary chiropractic, and homeopathy that were not considered conventional. Fueling the increasing interest in the clinical use of complementary and alternative approaches during this period was a dissatisfaction with limitations of conventional medicine. This growing effort to use complementary and alternative approaches clinically intensified the debate within the veterinary community. This debate had numerous aspects: 1) did the complementary approaches even provide reliable benefits for patients, 2) were those benefits consistent with or better than the conventional therapies, and 3) could (or should) the complementary approaches stand alone (used instead of the conventional therapies). The possibility that complementary and alternative approaches could be used alone contributed to the holistic approach to patient care. Veterinarians attending holistic meetings often asked each other what percent of their practice was holistic (as opposed to conventional). It became apparent that many veterinarians embraced the idea that there was a distinction between practice methods. Further, it became increasingly desirable to replace conventional therapies with complementary and alternative approaches as much as possible and to discontinue conventional methods when possible. This perspective fostered a drive to explore the clinical applications and limits of alternative and complementary approaches. Unfortunately, there was a lack of validated information about the clinical application of the alternative and complementary methods especially in veterinary practice. Veterinarians interested in the alternative and complementary therapies were faced with the task of extrapolating the limited information from human practice into veterinary applications. This required not only understanding the alternative or complementary modality but also determining how to apply these modalities to the unique requirements of veterinary species. Complicating this process of clinical exploration of alternative and complementary therapies, was the difficulty inherent in a veterinarian trained as a clinician attempting to function fully as an applied researcher striving to outline the basic application of alternative and complementary modalities based on validated research. Unfortunately, at that time, there was a severe lack of quality clinically applied research available to assist with this process. This, along with a lack of interest in research at academic institutions, delayed progress. With growing awareness of alternative, complementary, and holistic approaches and their use, there were increased opportunities for what appeared to be a conflict with conventionally trained veterinarians that had limited or no knowledge of the alternative or complementary methods. This provided opportunity for veterinarians with limited knowledge of alternative and complementary approaches to criticize these non-conventional methods. It became common in conventional practices and academic institutions to blame therapeutic failures on the use of the alternative and complementary therapies and on delays in seeking conventional therapy. Clearly this did occur, but, perhaps at least as often, many therapeutic failures occurred because conventional therapies delayed implementation of alternative and complementary methods. Often the criticism by conventional practitioners came from a lack of knowledge of the alternative and complementary approach. Obviously this was an unsound analysis of the |
situation. Fortunately, this is no longer the reflex response to the use of alternative and complementary therapies.
Early applied research into the alternative and complementary therapies was hampered by a lack of understanding of the alternative or complementary therapy. This translated into research protocols that were often not well designed and gave results that fostered misunderstanding of the clinical significance of the alternative or complementary therapy under investigation. The quality of research has increased as more researchers are designing research protocols based on an understanding of the alternative or complementary therapeutic approach. Progress toward accepting alternative and complementary therapies and developing clear concepts of their clinical application were further hampered by misapplication of the ideas of evidence based medicine. Many in the conventional community saw (and continue to see) evidence based medicine as being based exclusively on double blind placebo controlled studies. This is clearly not representative of full understanding and application of the concepts of evidence based medicine as originally proposed. Evidence based medicine is a combination of research results, clinical experience of the practitioner, and the values or perspective of the client. Quality research can take years to be developed, funded, implemented, and reported. These long delays are not of value for individual patients that are in need of more immediate supportive therapies. As clinical understanding of each modality has evolved along with more and improved quality research results, and growing awareness of the limitations of conventional medicine, there has been a wide spread societal interest in alternative and complementary therapies. This has created a need to address both the successes of alternative and complementary therapy and join them with the successes of conventional methods while creating new terminology to describe this joining. The term integrative veterinary medicine is a result of this joining. Integrative veterinary medicine should be an appropriate combination of conventional medicine and surgery with the previously considered alternative and complementary methods like acupuncture, chiropractic and other manual therapies, nutritional supplementation, homeopathy, western and Chinese herbal therapies, traditional Chinese (Oriental) veterinary medicine, essential oils, and other alternative therapies. Considered in isolation, each of these alternative or complementary modalities has advantages, disadvantages, and clear clinical applications. Understanding the veterinary application and extent of there clinical benefits has certain challenges. Effectively blending them together has its own difficulties because some combinations work well together while some can create inferences that reduce overall effectiveness. For example, strategic use of nutritional supplements can provide support for improving organ function response to conventional approaches like fluid and pharmaceutical therapies. On the other hand combining acupuncture and homeopathy together or acupuncture with certain drugs can reduce efficacy. This makes careful combination is important and requires training and clinical experience. Integrative veterinary medicine is more that offering an alternative or complementary modality along with the conventional approach. For example, offering nutritional supplements as part of conventional practice does not make a practice integrative. Likewise, offering acupuncture and laser therapy does not make a practice integrative. As part of the shifting landscape of terminology, as each alternative or complementary modality becomes accepted as part of conventional practice, it is no longer considered alternative or complementary. The goal of integrative veterinary medicine practitioners is to offer the best combination of therapies for each individual patient. This is a process of ongoing study, training and clinical experience. As such it should be continually evolving in a rational way that continues to provide optimal patient support and advances our collective understanding of integrative veterinary medicine. |
