The One Medicine movement is beginning to blur the boundaries between human and animal health. In many ways, encouraging collaboration among physicians, dentists, veterinarians and public health officials will benefit all parties. However, veterinarians must remain vigilant to ensure that practices adopted from human alternative medicine are rational, ethical and scientifically based. Consumers count on veterinarians and regulatory agencies to protect them from fraud and safeguard their animals’ health and well being. Consider the case of homeopathy. As the FDA stated, "Homeopathy is an alternative therapeutic modality developed in the late 1700s by a German physician for use in humans. Homeopathic medicine is considered an unconventional form of veterinary practice. ... There are currently no FDA-approved homeopathic drugs for veterinary use.”1 Homeopathic veterinarians prescribe what are essentially sugar pills, with little proof that they differ from placebos. Their academy publishes standards of practice advising against medications (e.g., analgesics, chemotherapy, cardiac drugs, etc.) as well as conventional therapy, including surgery for skin lesions.2 The British Medical Association has denounced homeopathy, maintaining that taxpayers should not have to financially support unscientific practices as part of the National Health Service.3 The U.K.’s Veterinary Medicines Directorate followed suit, holding that veterinarians cannot prescribe homeopathic remedies without evidence of efficacy.4 In short, animals deserve effective treatment. Chiropractic Functional Neurology Another problematic, though less well known, modality is chiropractic functional neurology. The approach began as "functional neurology” in human medicine, which involves electrodiagnostic assessment of nervous system disorders. Functional neurologists certified by the American College of Functional Neurology (ACFN) diagnose conditions such as sleep apnea, dystonias (movement disorders), attention deficit disorder, epilepsy and more.5 Chiropractors co-opted the term and morphed it into a holistic approach that uses manual therapy and other measures to "retrain the brain.” The field was pioneered by a Dutch chiropractor named Fred Carrick, who formed the Carrick Institute for Graduate Studies, where chiropractors now study to become board-certified diplomates in "applied chiropractic neurology.” Carrick published a paper in 1997 describing how cervical manipulation led to changes in cortical function, outlining specific neurological pathways transducing the effect.6 Carrick’s chiropractic colleagues exploded with criticism. Even his own graduate student contested Carrick’s claims, writing, "Unfortunately and incredulously so, many DCs continue to blindly and vehemently cling to BJ Palmer’s ‘mental impulse’ theory, despite its obvious shortcomings and fallacies.”7 In fact, chiropractors can now become "board-certified chiropractic neurologists” by passing an examination after only 300 hours of postgraduate training, most of which can be completed online.8 This obviously contrasts starkly with board certification requirements for DVMs, MDs and DOs who spend years in postgraduate residencies learning sophisticated scientific diagnostic approaches, evidence-based treatments and highly technical skills. Clients may not realize the distinction between a board-certified chiropractic and veterinary neurologist. Nonetheless, applied functional neurology is now creeping into the field of veterinary care. Courses for veterinarians on animal chiropractic teach its methods despite the lack of sound science and rigorous evidence.9 The problems do not stop there. More worrisome is the fact that functional neurology employs "manual muscle testing” (MMT) or "applied kinesiology” (AK) as an "assessment tool.”10 This approach, widely accepted and promulgated by chiropractors for the past 50 years,11 is used to "evaluate and correct functional imbalances in the structural, chemical, mental and energetic systems of the organism.” The practitioner asks the patient to resist his or her pressure by contracting a designated muscle. The strength of the patient’s resistance against the examiner’s hand determines whether a muscle is "weak” or "strong.” Muscle Strength AK practitioners make inferences about structural and internal medical conditions based on muscle strength, even though little relationship exists between the muscle tested and the organ linked to it. For example, a weak pectoralis muscle may indicate stomach dysfunction to an AK practitioner; a flaccid teres minor might suggest hypothyroidism.12,13 No scientific research proves these connections. Nevertheless, with "strong” meaning "good” and "weak” meaning "ill,” chiropractors have built busy supplement-selling practices testing remedies over reflex points and pushing on patients’ deltoid muscles seeing if holding the bottle changes the strength from weak to strong. In this way, a chiropractor can claim to "test” the function of the nervous system and how nerve firing changes with provocation. Apparently, enough consumers buy the lines and the products to generate healthy sales. Even more bizarre is the use of humans as surrogates for veterinary patients, because animals usually will not contract a specific muscle at an examiner’s request. An instructor of AK for animals writes, "Surrogate testing involves adding another human being to the equation. ... It was discovered early on in AK that babies and quadriplegics could be tested indirectly by having a third person touch them while the doctor tested the surrogate’s muscle for changes in strength. "The same tests or challenges are applied to the patient but the muscle testing response is through the surrogate. ... Surrogate testing allows us access to the animal’s inner physiology. ... How surrogate testing works is not really known at this time. It is hypothesized that neurological information, which is conveyed electrically, is transferred to the mostly salt and water surrogate by contact with the patient. Our lack of understanding of the mechanism of surrogate testing is a great shame.”14 So is the lack of evidence that muscle-testing human patients or clients on behalf of their animal can lend any diagnostic insights whatsoever. Jonathan Bolton, MD, from the Department of Psychiatry at Harvard Medical School, described an AK session between a chiropractor and human patient. He discussed how healthcare consumers are prone to consider "healers” trustworthy, especially when the latter present themselves as "qualified” and "sincere,” with knowledge and techniques "derived from truth,” whether or not the modalities they practice are valid.15 Veterinarians may trust in chiropractic neurology instructors for the same reasons that Bolton described, or they may be attracted to programs that profess to explain the cause of chiropractic "lesions” with lengthy descriptions of neuroanatomic pathways that may in actuality have little to do with the patient’s problem or effects of manipulation. As one of Carrick’s critics stated, regarding Carrick’s seminal work on functional neurology, "[N]o clinical significance can be ascertained from the topic as presented; there are multiple methodological problems with the research, he has concocted terminology that has no neurologic foundations and he presents no compelling argument or data to support multiple claims made throughout the article. As a result, we are reminded of a quote attributed to President Harry S. Truman: ‘If you can’t convince them, confuse them.’”16 Dr. Robinson, DVM, DO, Dipl. ABMA, FAAMA, oversees complementary veterinary education at Colorado State University. 1. Zimmer J and Land M. The current regulatory status of veterinary homeopathic drugs in the United States. American Association of Homeopathic Pharmacists website. Accessed at /redirect.aspx?location=http%3a%2f%2fwww.homeopathicpharmacy.org%2fpdf%2farticles%2fvet_drugs.pdf on 11-1-12. 2. The Academy of Veterinary Homeopathy. Standards of practice and purpose of the Academy of Veterinary Homeopathy. Accessed at /redirect.aspx?location=http%3a%2f%2fwww.theavh.org%2freferral%2fsop.php on 11-1-12. 3. Donnelly L. Homeopathy is witchcraft, say doctors. The Telegraph. May 15, 2010. Accessed at /redirect.aspx?location=http%3a%2f%2fwww.telegraph.co.uk%2fhealth%2falternativemedicine%2f7728281%2fHomeopathy-is-witchcraft-say-doctors.html on 10-31-12. 4. Harris E. Is homeopathy on the ropes after ban on prescription for pets? The Guardian. January 5, 2011. Accessed at /redirect.aspx?location=http%3a%2f%2fwww.guardian.co.uk%2fscience%2fpolitical-science%2f2011%2fjan%2f05%2fhomeopathy-ban-prescription-pets on 10-31-12. 5. American College of Functional Neurology, Inc. Functional Neurology News. Accessed at /redirect.aspx?location=http%3a%2f%2fwww.acfnsite.org%2fnews.php%3fpg%3d11%2327 on 11-1-12. 6. Carrick FR. Changes in brain function after manipulation of the cervical spine. J Manipulative Physiol Ther. 1997;20(8):529-545. 7. Seaman DR. Comment on "Changes in brain function after manipulation of the cervical spine.” J Manipulative Physiol Ther. 1998;21(4):295-6. 8. Online CE: Chiropractic Neurology Diplomate Courses. Accessed at /redirect.aspx?location=http%3a%2f%2fwww.chirocredit.com%2fpages%2fchiro_neurology.php on 11-1-12. 9. Options for Animals. Applied Functional Neurology. Accessed at /redirect.aspx?location=http%3a%2f%2fwww.animalchiro.com%2fcourse-curriculum on 11-1-12. 10. DeStefano CJ. Applied kinesiology and functional neurology in animal practice. Accessed at www.healthpioneers.net/art1.pdf on 11-1-12. 11. Gin RH and Green BN. George Goodheart, Jr., D.C., and a history of applied kinesiology. Journal of Manipulative and Physiological Therapeutics. 1997;20(5):331-337. 12. Bolton J. Trust and the healing encounter: an examination of an unorthodox healing performance. Theoretical Medicine. 2000;21:305-319. 13. Klinkoski B and Leboeuf C. A review of the research papers published by the International College of Applied Kinesiology from 1981 to 1987. Journal of Manipulative and Physiological Therapeutics. 1990;13(4):190-194. 14. DeStefano CJ. Applied kinesiology and functional neurology in animal practice. Accessed at www.healthpioneers.net/art1.pdf on 11-1-12. 15. Bolton J. Trust and the healing encounter: an examination of an unorthodox healing performance. Theoretical Medicine. 2000;21:305-319. 16. Troyanovich SJ, Roudebush M, Harrison D, et al. Comment on: Changes in brain function after manipulation of the cervical spine. J Manipulative Physiol Ther. 1998;21(4):297-299. <HOME>http://www.veterinarypracticenews.com/images/article-images/Narda-and-cat-200px.jpg5/21/2013 10:29 AM
