“Australian Veterinary Association (AVA) resources will not be used to promote therapies that, in the Board’s opinion, are not compatible with current understanding of physiology and pathophysiology and have been demonstrated to be ineffective by the current accumulated body of knowledge.”

This is part of a resolution passed by the board at the 18 May meeting in Canberra and you can see the full text of the resolution in the box below. So what is the purpose for such a resolution? Is this a Board obsessed with its power?

Last month I used this column to explain how AVA attempts to speak with one voice on matters relevant to our profession, through policies developed by members via the Policy Advisory Council (PAC) and approved by the Board. I briefly explained the difference between AVA policies, reflecting a majority profession-wide consensus, versus position statements, where an issue is very relevant but we as a profession have diverse opinions.

One of the most controversial issues over the past couple of decades within our profession is the level of evidence to support each of the expanding number of practised veterinary treatments.

In our undergraduate courses we are essentially taught to diagnose disease using principles of physiology and pathophysiology and to treat most disease states using a recognised mode of medicine or surgery, with the essential component being that scientific evidence supports the diagnosis and any intervention.

Yet upon graduating we find a broader range of options are practised than those taught at university, and as years pass new evidence, pharmacological agents and equipment, provide either more or less support for existing treatments that we were taught, and even herald altogether new treatment options.

As highly trained professionals, the issue is to define exactly what constitutes evidence worthy of our support, since veterinarians do not hold exclusivity in many of the processes and procedures performed on animals. In fact, unless a procedure is prescribed in the relevant Act as a vet-only procedure, and no harm is proven, it matters little to regulatory authorities whether any good has been achieved, and so a whole industry of less rigorously evaluated activities is able to flourish, to the point where the only tenet may be ‘First do no harm’.

Of course as veterinarians we too are really quite free to use our knowledge and skills as we see fit, to pursue a range of non-conventional treatments, although we are quite rightly more scrutinised and accountable by public expectation and regulatory bodies. While the debate over the quality of evidence abounds in scientific circles, the public can be forgiven for being lost in a blur, and the opportunity for populism to dictate acceptance becomes reality.

Further, many animal therapies are spin-offs from the human health arena, and we now have a better grasp of just how powerful the human placebo effect can be. I am not tempted to tackle the plausibility of placebo effects on animals in this space, but will touch on the question of evidence.

Clause 3.1 of the AVA constitution states “The main object for which the Association is established is to promote and advance veterinary and allied sciences in Australia.” And 3.2(q) is to “promote the fair, honourable and ethical practice of and research in veterinary and allied sciences, to suppress malpractice, to address disputed points of practice and to attempt to resolve all questions of professional usage and courtesy”.

Clause 23.1 states “It shall be the duty of the Board to transact the business, and oversee of the affairs of the Association”. As members we are also bound to observe the AVA Code of Professional Conduct which includes: “Veterinary procedures and recommendations should be based on sound evidence-based science and practice.”

These passages underline the governance responsibilities expressed in the above Board resolution. The essential element that separates this from a PAC policy is that as a Board we are exercising our responsibility, not over whether debates about research into or use of particular therapies should cease, but about the use of member resources to promote information regarding treatments that have been identified by the Board as unsupported “by the current accumulated body of knowledge”.

This is not a Board believing it is the peak arbiter on scientific evidence, simply the peak decision-maker for the affairs of the association.

The resolution means that therapies resolved by the Board to be ineffective cannot:

  • be the subject of AVA continuing professional development activities
  • earn AVA Vet Ed points
  • be promoted on AVA websites
  • be promoted in AVA publications, including division, branch or special interest group publications.

The resolution does not pretend to end the debate on evidence to support or reject any modality of therapy, provided that if using AVA resources, both pro and con arguments are aired simultaneously.

A second resolution was passed simultaneously stating: “That the Board agreed that the veterinary therapies of homeopathy and homotoxicology are considered ineffective therapies in accordance with the AVA promotion of ineffective therapies Board resolution.”

The Board is aware that this is a significant issue for the veterinarians who practise these two modalities, yet has acted as a matter of prudent governance outlined above. The Board has been in consultation with Integrative Veterinarians Australia (formerly Australian Holistic Veterinarians) for a considerable period prior to arriving at this decision. It is also important to state that the ‘ineffective therapies resolution’, while the direct consequence of negotiations with the Integrative Veterinarians Australia group, applies uniformly across our association on matters affecting our reputation to promote and advance veterinary and allied sciences in Australia.

Ben Gardiner
President

Promotion of ineffective therapies – 18 May 2012

The Board resolved that

Australian Veterinary Association (AVA) resources will not be used to promote therapies that, in the Board’s opinion, are not compatible with current understanding of physiology and pathophysiology and have been demonstrated to be ineffective by the current accumulated body of knowledge.

As professionals, veterinarians are free to choose the therapies they use and this resolution is not intended to affect clinical decision-making.

The AVA’s overall constitutional objectives are to “promote and advance veterinary and allied sciences within Australia”, and one of the core values is “Knowledge – we base our decisions on evidence, and actively seek out knowledge”.

Therefore the association’s resources must not be used to support and promote practices that, in the opinion of the AVA Board, have been demonstrated to be ineffective as therapies and that are not compatible with current understanding of physiology and pathophysiology. This means that the Board considers that the accumulated body of knowledge does not support continued use of these therapies.

For the purposes of this resolution, the term ‘promote’ means to advance or encourage the use, and publicise the efficacy, of a particular veterinary therapy.

The resolution means that therapies resolved by the Board to be ineffective cannot:

  • be the subject of AVA continuing professional development activities
  • earn AVA Vet Ed points
  • be promoted on AVA websites
  • be promoted in AVA publications, including division, branch or special interest group publications.

Presentations, articles or debates to discuss scientific evidence both for and against particular therapies are excluded from the definition of ‘promotion’. AVA resources may be used for presentations or debates about therapies providing both sides of the discussion are included at the same time and given equal opportunity to provide information or answer questions.

Peer-reviewed journals published by the AVA are exempt from this resolution. Editors may publish peer-reviewed papers presenting evidence for or against any therapies if the papers are deemed of scientific value by independent reviewers.

This story appears in the August 2012 issue of the Australian Veterinary Journal

Comments

cmiddle3397's picture

Many new vet graduates are keen to learn about integrative medicine modalities which are increasingly in demand from the animal owning public, because these therapies (including homeopathy and homotoxicology) have been proven to work for many conditions for humans and animals, and the public see them work for their own family, friends and animals.
The fact that a few AVA committee members insist on keeping their heads in the sand, pretending this is not happening, is going to increasingly make the AVA an unnattractive place for many new graduates. It is also likely to diminish the image of the vet profession in the eyes of the public.
So in a few years, don't say you were not warned.
But by then, maybe you will not care, because you will have retired from office and it won't be your problem anymore.

@Clare - It could alternatively be suggested that current veterinary use of some alternative medicines is leading to decreased reputation for the veterinary profession. If vets want to maintain their importance in areas of one health they will need to work with human medical practitioners utilizing an evidence based approach. The Australian Medical Association has removed all support for homeopathy and chiropractor treatments.

sscanlan2551's picture

If it works, it is called medicine.

If it doesn't work, it is called alternative, complementary or integrative. Doesn't matter what you call it, it doesn't work!

milan19096's picture

I guess we'll have to call Prednisone treatment for atopic skin disease an alternative, complementary or integrative therapy. Because, guess what, it doesn't always work! There is also no evidence base to say that it does, but veterinarians continue to use it as a first line treatment in atopy.

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