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AVMA takes action against Homeopathy???

D

Dantes

Guest
#1
Wasn't sure where to post this -- kinda urgent as apparently they are voting on this tomorrow....Saturday....never knew an agency could be so sneaky....

http://www.littlebigcat.com/blog/avma-resolution-against-homeopathy/

The American Veterinary Medical Association is at it again. This time, they are considering a proposed resolution against homeopathy. For support, they are using ONLY a “white paper” written by a vocal opponent of all things holistic, under the aegis of the Connecticut Veterinary Medical Association:
Resolution 3, submitted by the Connecticut Veterinary Medical Association, proposes that AVMA have a policy that states homeopathy is an ineffective practice and that its use as a veterinary therapy be discouraged. Two attachments have also been submitted: a white paper titled “The Case Against Homeopathy,” and a document with the current AVMA Guidelines for Complementary and Alternative Veterinary Medicine.
Here is the full text of the resolution:
RESOLUTION 3 — 2013
Regular Winter Session
Submitted by
Connecticut Veterinary Medical Association​
HOMEOPATHY HAS BEEN IDENTIFIED AS AN INEFFECTIVE PRACTICE AND ITS USE IS DISCOURAGED​
RESOLVED, that the American Veterinary Medical Association (AVMA) affirms that—​
1. Safety and efficacy of veterinary therapies should be determined by scientific investigation.​
2. When sound and widely accepted scientific evidence demonstrates a given practice as ineffective or that it poses risks greater than its possible benefits, such ineffective or unsafe philosophies and therapies should be discarded.​
3. In keeping with AVMA policy on Complementary and Alternative Veterinary Medicine, AVMA discourages the use of therapies identified as unsafe or ineffective, and encourages the use of the therapies based upon sound, accepted principles of science and veterinary medicine.​
4. Homeopathy has been conclusively demonstrated to be ineffective.​
Statement about the Resolution
The AVMA believes that the safety and efficacy of veterinary medical therapies should be established by scientific investigation. In the absence of clear scientific evidence of safety and efficacy, veterinarians must use caution in employing unproven therapies and must be guided by the dictum primum non nocere (first do no harm). When there is sound scientific evidence, and a clear majority of scientists agree, that a given practice is ineffective or poses risks greater than its demonstrated benefits, such ineffective or unsafe philosophies and practices should be discarded. Although veterinarians may legally employ any therapy that complies with the applicable laws and regulations governing the practice of veterinary medicine, the AVMA believes that veterinarians have an ethical duty to society, and to patients and their owners, to base medical judgments and recommendations on the best available scientific evidence.​
Rationale
Scientific validation of medical therapies encompasses a number of levels of evidence, including:​
1. A plausible theoretical foundation or mechanism consistent with accepted scientific knowledge, including well-established principles of physics, chemistry, physiology, and other scientific disciplines foundational to veterinary medicine.​
2. Supportive in vitro and animal model experiments demonstrating a biologic effect, dose/response relationship, or other evidence of actions that could potentially provide a therapeutic benefit.​
3. Clinical trial evidence, in the target species or in others, showing a consistent and clinically meaningful benefit and acceptable risks.​
The relative weight of these factors should be determined by the established hierarchy of evidence, with high-level and high-quality evidence outweighing that derived from lower-level and lower-quality research.​
It is not necessary for the scientific evidence to be absolutely uniform in order to establish that a practice is ineffective or unsafe. Safeguarding the welfare of veterinary patients and clients requires that veterinarians make reasonable judgments based on the available evidence and proportion the confidence in these judgments to the strength of this evidence. If there is strong scientific evidence that a practice is ineffective or unsafe, the existence of some lower-quality contrary evidence or a minority dissenting opinion does not preclude identifying the given practice as unsafe or without benefit. Like all judgments in science, such conclusions are predicated on the existing evidence and subject to reevaluation or reversal as new evidence is developed.​
Specific Practice: Homeopathy
Specific veterinary therapies may be identified by the AVMA as unsafe or ineffective based on a thorough evaluation of the available scientific evidence and a general agreement among scientists that the balance of the evidence demonstrates the practice to be ineffective or unsafe. The AVMA discourages the use of such therapies.​
With respect to the practices known as Homeopathy, there is strong, widely accepted scientific evidence that the theoretical foundations of homeopathy are inconsistent with established principles of chemistry, physics, biology and physiology. Further, extensive clinical trial evidence has shown the practice of homeopathy has been ineffective in treating or preventing any disease. While homeopathic remedies are not inherently unsafe, the use of ineffective therapy to the exclusion of established treatment may endanger patients.​
Addendum 1: White paper: “The Case Against Homeopathy”
Addendum 2: AVMA Guidelines for Complementary and Alternative Veterinary Medicine​
The shameless and corrupt behavior of a few hidebound “skeptics” are creating a hostile environment for the practice of holistic medicine. If you know any veterinarians sympathetic to complementary and alternative therapies, please encourage them to write to their AVMA representative. You can write to the AVMA as well (info@avma.org), because they evidently don’t get that homeopathy is something that our clients want.​
I’m copying my personal comments to AVMA below, and you can find a copy of the American Holistic Veterinary Medical Association (AHVMA) comments here: http://ahvma.org/images/stories/ctproposalevaluation.pdf. AHVMA also put up a list of studies that prove homeopathy works, at http://foundation.ahvma.org/images/homeopathy white paper-1.pdf.​
An excellent website with references that support homeopathy is http://www.extraordinarymedicine.org/2011/01/14/extraordinary-evidence-homeopathys-best-research/.​
We lost on the raw food debate (although the final resolution was watered down to appease the masses), and we will probably lose on this. But there’s no harm, and potentially great good, in trying. You can tell your personal stories, as well as emphasizing that you demand access to homeopathy for your animal companions; and if veterinarians won’t do it, you’ll be forced to turn elsewhere. That will threaten their pocketbooks. I think AVMA would be quite surprised to get a big public response. So–have at ‘em!​
 
D

Dantes

Guest
#2
continued:
I was surprised to hear that AVMA is considering a resolution that would permanently declare homeopathy to be ineffective based on a single anonymous paper which, upon examination, is full of bias and inaccurate information.
The AVMA Guidelines for Complementary and Alternative Veterinary Medicine [CAVM] states: “It is not the intent of these guidelines to determine or describe the relative value of the individual modalities.” Therefore, this document irrelevant to any discussion on the merits of any particular therapy, including homeopathy.
The “white paper” (The Case Against Homeopathy) is quite interesting, but it has multiple fatal flaws. Let me point out a few of the issues:
1. No authorship is claimed. Who wrote it? What are his qualifications? While HOD rules allow such resolutions to be considered, the unwillingness of the author to proudly set his name upon this paper suggests that he is not a credible sources—and he knows it. If he had any qualifications or expertise in the matter, he would have said so. AVMA should consider this lack of transparency and dearth of qualifications when evaluating this paper.
2. The author’s comparison of homeopathy to magic and voodoo, and his use of examples from ethnobotany and folks traditions that have nothing whatsoever to do with homeopathy, reveals his agenda: to kill homeopathy. It is not a real “white paper,” it is an editorial; an opinion piece. AVMA should regard this paper in light of its blatant bias.
3. The author states that “While habit, tradition, uncontrolled clinical experience, and anecdotes may appear to support the value of a given therapy, these sources of information are deeply unreliable.” However, any pharmaceutical company would tell you that “traditional” remedies have given us innumerable drugs (aspirin, digoxin, and taxol come readily to mind); and ongoing research into folk remedies and herbs is our greatest resource for future drugs.
Contrary to the author’s position, clinical experience and anecdotes are, in fact, evidence. EBM has yet to settle on a single system of classification for levels of evidence, let alone the incomplete version contained in the AVMA’s “Statement about the Resolution.” In fact, that statement lists only three levels; I know of no currently accepted system using less than four. A more comprehensive system (http://med.fsu.edu/userimages/EBMPyramid2008-02-26.gif) ranks the levels as follows from most to least reliable as follows:
A. Cochrane Systematic reviews
B. Other SRs and meta-analyses
C. Evidence guidelines
D. Evidence summaries
E. RCTs, Case Cohorts, Control Studies
F. Clinical Research Critiques
G. Other Reviews of the Literature
H. Case reports, case series, practice guidelines, etc.
The white paper itself could qualify perhaps next to last (“other reviews of the literature”); but even that is an overly generous score, given that it “reviews “only the papers most supportive of the author’s own position.
4. Table 3 admits in its title that the studies chosen for the list were “SELECTED.” Of course they were. It’s easy to find references to back up either side in virtually any scientific debate. The results of an individual study can also be interpreted in different ways, depending on the point one wants to make.
Take another look at Table 3—half of those references were published between 1966 and 1998. Or check the grand total of 72 references. Apparently, out of 4,622 items on homeopathy indexed on PubMed, the anonymous author could only find 72 (1.3%) that support his contentions? If AVMA is to take this issue seriously, then it should consider all studies on homeopathy, not just the 16 chosen by the die-hard “skeptic” who authored the white paper.
5. According to Table 3, science stopped working sometime in 2010, because no more recent citations are included. That is likely because newer research does, in fact, provide evidence for the mechanism of homeopathy, as well as strong evidence of its efficacy.
Coincidentally, 2010 was the same year that Homeopathy published a report on a massive 2007 experiment in Cuba that used a homeopathic remedy to supplement its limited stocks of leptospirosis vaccine. The disease is a huge problem in Cuba, and it is monitored meticulously. A news report stated, “The homeopathic medicine was given to the 2.3 million population of the provinces usually worst affected. Within a few weeks the number of cases had fallen from the forecast 38 to 4 cases per 100,000 per week, significantly fewer than the historically-based forecast for those weeks of the year. The 8.8 million population of the other provinces did not receive homeopathic treatment and the incidence was as forecast. The effect appeared to be sustained: there was an 84% reduction in infection in the treated region in the following year (2008) when, for the first time, incidence did not correlate with rainfall. In the same period, incidence in the untreated region increased by 22%.” (Homeopathy Associated With Dramatic Reduction In Leptospirosis Infection In Cuban Population. http://www.medicalnewstoday.com/articles/197128.php) The lead authors were not homeopaths; they were physicians and respected vaccine researchers. Cuba has since implemented homeopathic prophylaxis against leptospirosis for its entire population and is considering it for other diseases.
6. The white paper’s excessive reliance on the House of Commons Science and Technology Committee (HOC Committee) report on Homeopathy (HOC Committee 2010), which was ultimately rejected, is pathetic.
7. The white paper states that the articles supporting homeopathy are published “almost exclusively” in journals sympathetic to alternative therapies. Of course, it is logical that most of the articles on a given topic will be published in journals about that topic. One would not expect the bulk of articles on molecular biophysics to be published in the New England Journal of Medicine.
Nevertheless, that statement is simply not true. I reviewed a small sample of abstracts and papers indexed on PubMed. Journals that have published papers favorable to homeopathy (and which are not in any way sympathetic to CAVM) include:
· Annals of the New York Academy of Sciences
· Current Oncology
· Der Urologe (Urology; Berlin, DE)
· Experimental Biology and Medicine
· European Society for Philosophy of Medicine and Health Care
· European Journal of Pharmacology
· Frontiers in Bioscience (Scholar Edition)
· Immunology Today
· Immunological Investigations
· Journal of Allergy and Clinical Immunology
· Journal of Analytical Methods in Chemistry
· Journal of the European Histamine Research Society
· Journal of the Federation of American Societies for Experimental Biology (FASEB)
· Journal of Immunology
· Journal of Inflammation Research
· Journal of The Royal Society for the Promotion of Health
· Medical Hypotheses
· Micron
· Molecular and Cellular Biology
· Psychopharmacology
· Preventive Medicine
· Wiener klinische Wochenschrift (Central European Journal of Medicine)
 
D

Dantes

Guest
#3
continued:
Moreover, completely disregarding every study showing positive results of homeopathy because the unknown author doesn’t like the journal in which it was published is hardly a scientific approach. It’s even more peculiar because 1/3 of the white paper’s own references are to the very journals dedicated to CAVM that it disparages.
For example, under the heading “direct harm,” the white paper states, “There have been some reports of detectable heavy metal contamination of homeopathic remedies.” That’s true only if you consider “some” to be equal to “one,” because that’s precisely how many reports actually exist. Ironically, that single report was published in the journal Homeopathy, which the author regards as completely unreliable as scientific evidence of anything. (If one compares this to any analysis of morbidity and mortality associated with legal prescription drugs, the white paper clearly overstates the risks associated with homeopathy.)
8. The author is critical of the quality of published studies on homeopathy. Perhaps he has not noticed that studies published in medical journals are not without flaws:
· Investigators found that studies with positive results and higher statistical significance are more likely to be published, and published years sooner, than studies with null or negative results. According to Cochrane Summaries, the entire validity of a systematic review is seriously threatened by such publication bias.
· A 2005 paper concluded, “Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true.” Subsequent papers by the author have shown that bias in published research is a widespread and fundamental problem.
· The NEJM was mightily embarrassed when it published a drug-company funded study defending its products against research showing the drug to be dangerous. The journal lost its prestige; and the editor later commented, “It is simply no longer possible to believe much of the clinical research that is published.”
9. The white paper falsely claims that the FDA “has made no attempts to regulate their use or require any evidence of safety and efficacy.” The FDA itself contradicts the author on its website:
“The Federal Food, Drug, and Cosmetic Act (the Act) recognizes as official the drugs and standards in the Homeopathic Pharmacopeia of the United States and its supplements (Sections 201 (g)(1) and 501 (b), respectively).” The FDA also recognizes the HPUS as “A compilation of standards for source, composition, and preparation of homeopathic drugs.” I personally spoke with an FDA representative, who was emphatic that FDA has no plans for any changes or challenges to the HPUS.
In summary, Resolution 3-2013 should fail for the following reasons:

1. It is prejudiced. The anonymous white paper in support of the resolution is highly biased, deeply flawed, and outdated. It relies on cherry-picked data, makes multiple false statements, and ignores recent findings supportive of homeopathy. The many errors, whether deliberate or not, make reliance upon it untenable. Moreover, it usurps the power of the state boards to define the practice of veterinary medicine. Frankly, it’s none of AVMA’s business what modalities (or drugs, or surgeries) individual veterinarians use as long as they are legal and within the scope of their state’s practice act. Furthermore, when an author knowingly makes even one false or misleading statement (and the white paper’s author makes many), it throws every other claim that author makes into doubt. The white paper simply cannot be relied upon as evidence of any truth.

2. It is petty. The resolution is uninformed and narrow-minded. It segregates and vilifies a specific segment of AVMA’s own membership. AVMA has already gone a long way down the path of alienating every CAVM practitioner by its resolution against raw meat diets, which many veterinarians recommend. I cannot imagine why AVMA wants to drive out so many members, but adopting this resolution would only increase the gap in understanding between EBM fanatics and veterinarians with an interest in expanding the tools available to help animals.
3. It is perverse. The public wants CAVM, and in particular, our clients want CAVM. Veterinarians themselves want knowledge and training in all CAVM modalities, including homeopathy. At conferences I’ve attended, the lectures on CAVM have been extremely popular. However, at this year’s AVMA conference, the lecturers on CAVM are individuals who are outspoken opponents of most or all alternative modalities. It is clear that a small group of highly vocal CAVM skeptics have already overtaken any remnant of common sense and fairness at AVMA. This resolution will take the AVMA further backward into an era more reminiscent of the Salem witch trials than a move forward into the demands of the new millennium. This resolution is completely antithetical to AVMA’s own best interests.
4. It is premature. Why this sudden rush to judgment now? While the mechanism of action of homeopathy has not been conclusively determined, recent research (excluded by the white paper) suggests several possibilities. Research is expanding. A reasonable judgment of any kind on homeopathy is not possible without simply ignoring studies published in late 2010 and thereafter. The issues are as yet unsettled, and future research may completely contradict the white paper’s allegations. If so, passing this this resolution now will make AVMA look pretty foolish.
A recent study on therapies for menopause stated: “…there has been a burgeoning interest in a number of botanical products as well as other complementary and alternative medicine strategies, such as acupuncture, magnets, homeopathy, and behavioral regimens. However the benefits of most of these strategies are either very limited or equivocal, and related safety issues are poorly understood. Future research is needed to identify new efficacious strategies, to understand side effects and safety issues, and to provide new options.” (Emphasis added)
The official U.S. Homeopathic Pharmacopeia currently states that “although the theoretical basis of its scientific methodology has remained constant, its format and documentation have evolved, and will continue to do so.” (Emphasis added.)
In the past few years, a very small group of alternative medicine “skeptics” has gained undue influence over the whole of veterinary medicine. This has been manifested in the shift within RACE to universally withhold approval for all courses on alternative modalities (many of which were identical to previously approved courses), AVMA’s and other organizations’ resolutions against raw-meat diets, and AVMA’s choice to turn over its conference CAVM lectures to people who are opposed to some or all modalities within CAVM. This small group, by being extremely vocal and using false arguments, wants very badly to be in control of the debate. They are attempting to establish their views as AVMA policy before it’s too late; i.e., before anyone else fairly evaluates the current science, and certainly before nanophysiology and other methods of measuring the effect homeopathic remedies are fully developed. It’s a sad day for veterinary medicine when the profession turns its back on progress.
AVMA would be very unwise to approve this resolution, as it is based on false and misleading information. I urge you to reject it.
Sincerely,
Jean Hofve, DVM
P.O. Box 100324
Denver, CO 80250
AVMA Member #0034812
 

admin

Paige
Staff member
#4
This is all pretty outrageous! Thanks for posting! I hope we can make a difference

Sent from my DROID RAZR using Tapatalk 2
 

SV Dad

Savannah Super Cat
#5
Well........ I am probably going to offend a bunch of folks. Sorry.

Respectfully, I would endorse this proposed AVMA resolution position. I am in the pharmaceutical field. I am well qualified to comment on evidence based practice, especially medications. And when it comes to the care of myself, my family, and my dear cats, I want evidence based clinical decisions.
On a daily basis I see first hand the results of this standard (yes, this is anecdotal reporting!).
To clarify, I do not feel the homeopathic medications can pass the muster of clear evidence of safety and efficacy. Though I will agree the safety part is very unlikely to be an issue.

Alternative herbal approaches. On this position I am quite open. The challenge here, is to gather more supportive evidence of efficacy, and at 21st century criteria. To dilute down a botanical product to exponentially low levels (as in homeopathy) is not an alternative herbal approach.

If an individual wants to use this homeopathic approach, go ahead. Fine with me. And it probably won't make any difference other than psychological comfort. Meanwhile, the problem needing treatment is not resolved.

This one quote "With respect to the practices known as Homeopathy, there is strong, widely accepted scientific evidence that the theoretical foundations of homeopathy are inconsistent with established principles of chemistry, physics, biology and physiology. Further, extensive clinical trial evidence has shown the practice of homeopathy has been ineffective in treating or preventing any disease. While homeopathic remedies are not inherently unsafe, the use of ineffective therapy to the exclusion of established treatment may endanger patients." pretty much says it all. (emphasis added)

I accept that my bias is based on human models, not veterinary practice.

And to be pragmatic, ethical and professional conduct, could be questioned in litigation when treatment options utilized recommendations "not proven to be harmful", as opposed to evidence based best practice.

My last point, if there is a compound in plants that is pharmaceutically active, and has the potential to moderate a specific condition, the pharmaceutical industry is hell bent on finding that compound, to market and reap outrageous profits. (Now I've offended pharmaceutical companies. Add them to the list. But they have that coming to them.)
 

John Popp

Site Supporter
#6
Call me naive, but I just don't get it. Why does this need to exist and what are the motivations? Who funds the vast majority of studies available and who profits? Who are the AVMA police who are going to knock on clinics doors, pull their records and reprimand non-complying veterinarians?

Anyway, my wife and I have open and honest conversations with our vet just the same as we do with our doctors. Prescription medication is always the last alternative, and far too often the cure ends up to be worse than the disease. The pet food industry has been consumed with large conglomerates such as Mars, P&G, Del Monte, Colgate-Palmolive and Nestle. Profit is always the first motivator for these large companies, just the same as the target of this resolution.
 
D

Dantes

Guest
#7
If an individual wants to use this homeopathic approach, go ahead. Fine with me. And it probably won't make any difference other than psychological comfort.
I'm not the least offended by your opinion; however, there is great evidence that many "scientifically approved" drugs don't truly make any difference other than psychological comfort, either.

Starting with that premise, why come out with a policy that limits my access and ability to use my chosen remedy? This is the issue that I have with what is going on. We are quickly (and no longer quietly) losing all of our freedoms to greed. Because big pharma has the ability to squash the competition for monetary gain, my choices are being limited.

My cat had incurable brain cancer. A regular vet who insisted his cancer was curable performed surgeries and gave him medicine that was harmful. I trusted in science, and as a result, my baby's last few months were horrific and painful, and I am thousands of dollars poorer. It was his vet that *also* practiced homeopathy and alternative medicine that helped him the most. I wish I had known her sooner, my boy may have died a few weeks earlier but with much less pain and torture.

My Dante was seen by 3 "traditional" vets who all told me "some cats are just like that" (ie. inappropriate bloody urination) because their science had no answers. I went to my holistic vet who suggested trying flower essences (in addition to a raw diet that is now considered "risky" and "to be avoided" by AVMA). Yeah, right I thought...but you know what? The raw diet made the blood in his urine stop, and the flower essences DID--and DO--visibly change his mood. Without anti-depressants, which I might point out have been shown to have no better effect on depression than a placebo. But this scares the AVMA, because Big Pharma has lost a ton of cash.

I watch as my friends get older and take drugs and have surgeries, and instead of them getting better, I see them getting worse and older and more tired looking (even more old than they actually are) with side effects and complications. I no longer trust in the type of "science" that is being thrust at me, I freely admit that. I have the ability for scientific reasoning, but if science means blindly trusting a doctor or blindly trusting that a pharmaceutical company knows everything or has my best interests at heart, then no, that is not going to happen for me.

Seeing this trend with the AVMA has made me even more distrustful. They start with saying homeopathy doesn't work for animals; well, that's animal testing for you! Suddenly homeopathy is not allowed for humans either. What else will they take away? Chinese medicine? Ayurvedic? Herbal? Chiropractic? What about the efficacy of organic foods? I'm sure Monsanto would love to see them prohibited too....

You might be okay with your "science" being the only permitted treatment. I'm not. I want MY science to be allowed, for my intelligence to count for something. Why do you feel the need to infringe on my right to choose? I can think and reason, and I no longer think that big pharma is interested in keeping me healthy; they just want my money and don't care if I get sicker or need to take 10 more drugs to counter the side effects of the first, more money for them.

Kind of a rant, but I'm going birdwatching (no, Duma's not coming lol) so no time to make my thoughts more cohesive. Just had to get it out.
 

Patti

Admin
Staff member
#8
Both sides to this argument make valid points. I believe in evidence based medicine, however I know that there are also complimentary therapies that can also be useful. In fact, my cardiology practice has incorporated complimentary therapies as one of the many services we provide. We did not go into this haphazardly, rather studied many different options, settling on those that are also research based. No, these therapies are not FDA approved, however that doesn't mean that their research is any less valid.

It is true that the pharmaceutical companies want our money however, they also want to avoid huge class action lawsuits, so they are not going to purposefully dupe the FDA and release a drug that is ineffective, or worse unsafe. On the other hand, research is not real life, no matter how many thousands of subjects have been tested so on occasion there are glitches, and some medications that initially show great promise end up falling short. The bottom line is, FDA approval is no magic wand or guarantee that a drug is safe and effective but it does mean that every approved drug has gone through a rigorous process to get approval so chances are good that is will do what it claims to do. However, that does not mean that non-FDA approved therapies are any less effective, but it is our responsibility to do the research and make sure we know what we are using, including the risks and benefits of any therapy we consider.
 

John Popp

Site Supporter
#9
The medical profession is filled with doctors who would rather write a script than to tell a patient they need to undergo a lifestyle change, lose a few pounds or quit smoking. It begins with the pharmaceutical PAC Trust that pays for junkets, golf outings and vacations, then ends with a rainbow colored daily prescribed death spiral. Not pointing fingers at all as there are plenty of good doctors out there but we have a society where people make poor health choices every day, Agribusiness feeding people and pets poison food and the pharmaceutical industry ready to step in and make a profit.

Quite simply too much of what ails us or our pets can be handled outside a trip to the pharmacy and unfortunately that leads too many of us with the need to play Dr Google and get an associates degree in medicine.
 

SV Dad

Savannah Super Cat
#10
Thanks for a nice civil debate. I really do appreciate seeing other points of view.
I would not say I am a "supporter" of the pharmaceutical manufacturers. I have become fairly critical of their shenanigans over the years. And the FDA hasn't exactly been pure lately.
It may be hard to understand that pharmacists do not consider medications as first choice of treatment. It is actually a profession which promotes appropriate rational medication therapy. I look for opportunities for non pharmacological treatments. Once a drug is onboard, Pandora has a chance to get out her box and start mischief. I do clinical evaluations in skilled nursing facilities. I get to see what really helps and what doesn't on a daily basis. I am also on the lookout for harm. This is a challenge.

My point of view is evidence based best practice, with a healthy dose of quality of life perspective. This too is a challenge in tough situations. Additionally health professionals are always a target for litigation whether or not the situation was affected by decisions or recommendations of a health professional. This is a factor when treatments are not known to be safe and effective.

Professional organizations serve a purpose in setting practice guidelines for their particular profession. The proposed position of the AVMA appears to discourage non proven treatments. An argument could be made that saying nothing is better than saying something is inappropriate, as that could encourage litigation. And conversely, if some standards were not established, professions would be hard pressed to improve the quality of care.

Does the patient or their designee (owner in this case) have the right to make the final call on treatment? Absolutely, and it should be realized that the outcome is owned by the person making that decision.

Another point made is decisions either made or influenced by greed. Abhorrent. Obviously unprofessional. This is where litigation is necessary.

Scientific evidence. A real challenge here is to get to the truth of what is being studied and not have an ulterior motive. This is why peer review is so important before publishing results. But a well designed study with undeniable results leads to progress. If we as a community based decisions on conjecture or what sounds good, we would not have progressed to where we are today.

Setting aside the aforementioned, this chat board provides the savannah community with information, knowledge, assistance, discussions, alternative ideas, and emotional support. These are special creatures and I am impressed by how much we all want to keep them safe, happy, and healthy.