Mar 072010
 

In the equine world there are many sellers of goods and services who say that their products will make your horse healthier, or happier, or easier to ride, or more likely to win competitions. How can you evaluate these claims, and sort out the facts from the fiction? And when does it matter?

It matters most when it affects your horse’s health. Once, if your horse was unwell you called the vet. Nowadays you can call on a whole range of therapists and practitioners. Some of these people may also be vets. Others may not, and might even be working illegally (in many countries, it is against the law for anyone other than a qualified vet to treat an animal except in certain defined instances). Veterinary medicine is far from perfect, but “vets don’t know everything” doesn’t mean that they know nothing. Scientific veterinary treatment is based on a thorough and well-established understanding of equine biology, from the whole animal right down to the atoms and molecules within its cells, and on the nature and causes of illness. In contrast, many alternative treatments are based on ideas that are not consistent with what we know about the laws of biology, chemistry and physics. Scientists don’t know everything, but we know enough to be able to say with confidence that although some are more plausible than others, most alternative therapies cannot possibly work in the way that their proponents say they do.

So, that being the case, how is it that so many people swear and declare that therapy X “worked for them” and cured their cystitis, or backache, or their horse’s scabby skin, or whatever? It is because it isn’t possible to tell, from personal experience alone, whether something works or not. If we do A and B happens, it is all too tempting to assume that A causes B, when in fact B might have happened for one or more of many other reasons. This is why the scientific method developed: people realised that observations and experience alone – even careful, patient observation by many people over many years – were not enough to determine what is true and what isn’t. The scientific method is a way of testing things objectively, eliminating as far as possible our tendency to jump to the wrong conclusion. Scientists certainly start with observations, but instead of stopping there and assuming that A must cause B because their observations suggest so, they go on to devise experiments to test whether A does in fact cause B. Only if many experiments, done by many people looking at different aspects of the question, all tend to give the same answer do they tentatively conclude that yes, A does cause B.

The total evidence to date suggests that almost all alternative therapies “work” through placebo effects (feeling better because you expect to, among other things). This includes animals and babies, contrary to popular belief: because animals and babies can’t tell us how they really feel, the effects of a therapy are assessed by the owner, parent or practitioner; people who are very likely to see an improvement because they wish to see one. Animals who don’t know they’re being treated are unlikely to experience placebo effects in the same way that people do, but they can be conditioned to respond in a certain way to treatment, and this can lead their owners to report apparent improvements when nothing has actually changed (Ramey 2008, Bartimaeus 2009, Averis 2010).

Although most owners would recognise a genuine emergency and would not hesitate to call a vet for something like a suspected fracture, or colic, alternative therapists do get called upon for the sort of low-grade, minor, irritating-but-not-life-threatening chronic conditions, aches and pains for which there really isn’t any treatment, either in horses or humans. Because many of these conditions do go away or improve on their own, the therapy is likely to get the credit. The danger here, of course, is when the horse does have a serious condition and the owner, impressed by the apparent success of a therapy, calls the therapist to deal with something that really needs a vet. As the vet RPC Coombe wrote recently in the British horse magazine Equi-Ads: “If you notice a loss of performance, what order of investigation do you instigate? If the answer is riding friend(s), instructor, osteopath, chiropractor, physio, back man, saddler, farrier, quack and the yard dog before the last resort, the vet, then beware! Time and therefore prognosis may be squandered potentially at the expense of long term soundness.”

Science also matters in training horses. Nowadays there seem to be almost as many training methods as there are trainers. Some base their methods on tradition: methods that have been found to work over many years. Others are trying ways supposedly based on the natural behaviour and social relationships of the horse. And a great many people, from both camps, get it wrong. Recent studies published by the International Society for Equitation Science (ISES) suggest that over 80%, and in some populations over 90%, of ridden horses demonstrate a behavioural problem (Hockenhull & Creighton 2008; 2009). Inappropriate behaviour is one of the main reasons for horses being sold on from training yards (Hayek et al. 2005), or given to horse charities because they are too dangerous to ride (Waran 2005). A surprising number of horses referred to a veterinary hospital with suspected clinical problems were found to be physically healthy but to have behavioural problems inadvertently trained by their owners (Waran 2005). Horses think like horses, behave like horses and learn like horses regardless of what we believe, and regardless of what we think we are teaching them. In both health and training the facts, the laws of nature, the nature of horses, hold true despite what we would like to be true. It seems entirely reasonable, therefore, to look at the results coming out of the sciences of learning and animal behaviour, and to develop training methods based on those. This is the aim of ISES (see above and reference list below). The society was founded by a group of people who felt that many of the current difficulties in training and animal welfare were the result of the lack of science in equitation. Many riders expect their horses to think and reason as a person would; to make sense of signals a person would find confusing; and to act with far more consistency than they do themselves. Knowing more about how horses’ minds and bodies work can only help to make our expectations more reasonable and our communications more comprehensible.

Many commonly-accepted ideas in the horse world are based on unsupported belief rather than on biological reality. Too much nonsense has become mainstream in the horse world because too few people are willing or able to question what they are told. That includes those selling the ideas, as well as their customers. The problem is one of misguided belief, not of dishonesty.

So – here are a few of these questionable ideas. But don’t just take my word for it: please follow the links, read the evidence and make up your own mind.

  • Anything – therapy, training method, supplement or feed – that uses the words ‘magic’ or ‘miracle’ or promises instant cures for chronic conditions or problems. These are not valid biological processes (Carroll 2009).
  • Any therapy based on the idea of manipulating or rebalancing some sort of mysterious, undetectable ‘energy’ or vital force. Not only is there absolutely no convincing evidence whatsoever for any such force, there is no need to look for one: the clinically significant goings-on of the body are already perfectly well explained by processes and structures that are known and well understood (Crislip 2008; Stenger 1999). ‘Energy’-based therapies are generally survivals of ideas from a time when people didn’t know how bodies worked, and this was their best explanation in the absence of knowledge about blood circulation, the nervous system, microbiology and biochemistry.
  • Anything that claims to be safe and beneficial because it is natural. Many natural things, from virulently poisonous animals and plants to earthquakes and volcanoes, are extremely dangerous. Many synthetic substances, such as purified active ingredients in drugs, are safer than the raw plant materials from which they are derived. More on this in another article.
  • Anything claiming to ‘boost the immune system’. This is scientifically meaningless, cannot be tested, and in any case there is nothing a normal and healthy animal (horse or person) can do to improve immune function (Crislip 2009). Indeed, would you want to? Many equine problems such as COPD and other allergies are the result of an overactive immune system, not a weak one.
  • Anything where the proponents say that science – especially if they call it ‘Western science’ – cannot be used to test their claims. With sufficient ingenuity, anything can be tested. What these people generally mean is that science is fine when it supports their ideas, but when it fails to support them, it is because the scientific method is useless, not because their ideas are wrong.
  • Funnily enough, anything that is advertised as ‘supported by science’. What this often means is ‘there are one or two weak, just-about-positive studies out of the thousands of negative ones that have been done’. Advertisers can almost guarantee that their readers will not look up the references to check, even if they are able to do so.
  • Training methods (or therapies) based on ideas that contradict most people’s understanding of reality, especially if developed or promoted by one person, and even more especially if that person claims to be a misunderstood genius. Lone geniuses are rare, and idiosyncratic ideas generally turn out to be wrong (Skeptvet 2010).
  • Training methods based on the concepts of leadership, or dominance/submission, or the idea that a horse must respect his trainer before he can be trained. These ideas may be at odds with learning theory (Goodwin et al. 2008).

By Alison Averis is the editor of Equine Behaviour, the quarterly journal of the Equine Behaviour Forum. (www.gla.ac.uk/External/EBF/)

(Enjoyed this article? Then please donate a little to The Equine Independent to keep us writing without a subscription. You can donate via paypal to mail@theequineindependent.com. Even the smallest amount is greatly appreciated. )

References and Further Reading –

Averis, AM (2010). Horse health, management and training – why we need science. This website.

Bartimaeus (2009). The placebo effect in animals, and their owners. www.skeptivet.blogspot.com/2009/07/placebo-effects-in-animals-and-their.html

Carroll, R (2009). Magical thinking. www.skepdic.com/magicalthinking.html

Crislip M (2008). Impossibilities. www.sciencebasedmedicine.org/?p=204

Crislip M (2009). Boost your immune system? www.sciencebasedmedicine.org/?p=1828

Goodwin D, McGreevy P, Waran N & McLean A (2008). Horsemanship: conventional, natural and equitation science. In Proceedings of the 4th International Equitation Science Symposium 2008. Ed by J Murphy, K Hennessy, P Wall & P Hanly. www.equitationscience.com.

Hayek AR, Jones B, Evans DL, Thomson PC & McGreevy PD (2005). Epidemiology of horses leaving the Thoroughbred and Standardbred racing industries. In Proceedings of the 1st International Equitation Science Symposium 2005. Ed by P McGreevy, A McLean, A Warren-Smith, D Goodwin & N Waran. www.equitationscience.com.

Hockenhull, J & Creighton, E (2008) The prevalence of ridden behaviour problems in the UK leisure horse population and associated risk factors. In Proceedings of the 4th International Equitation Science Symposium 2008. Ed by J Murphy, K Hennessy, P Wall & P Hanly. www.equitationscience.com.

Hockenhull, J & Creighton, E (2009). Equipment and training risk factors associated with ridden behaviour problems in UK leisure horses. In Proceedings of the 5th International Equitation Science Symposium 2009. Ed by P McGreevy, A Warren-Smith & C Oddie. www.equitationscience.com.

Ramey, D (2008). Is there a placebo effect for animals? www.sciencebasedmedicine.org/?cat=290

Skeptvet (2010). Warning signs of quackery ahead. www.skeptvet.com/blog (February 28 2010).

Stenger, V (1999) Energy Medicine. In Alternate therapies in the horse (with D Ramer). Howell Book House, New York. www.colorado.edu/philosophy/vstenger/Medicine/EnergyMed.html

Waran N (2005). Equestrianism and horse welfare: the need for an ‘equine centred’ approach to training. In Proceedings of the 1st International Equitation Science Symposium 2005. Ed by P McGreevy, A McLean, A Warren-Smith, D Goodwin & N Waran. www.equitationscience.com.

Useful websites for investigating the scientific consensus about the various therapies and practices

The Skeptic’s Dictionary www.skepdic.com. An excellent source of information about all sorts of topics connected with science, pseudoscience and critical thinking. Before you try some new therapy or treatment on your horse, check it out here.

www.skeptvet.com. Internet blog by a veterinary surgeon, with some good articles about the use of various alternative treatments on animals.

  14 Responses to “Horse Sense or Nonsense: How Do You Decide? By Alison Averis”

  1. Although i don’t have a problem with questioning therapies/suppliments etc. I do have a problem with you posting this as fact when there are other articles/books or whatever, disputing many of the points you have said here.

    You can’t prove to me all swans are white by showing me 1000 white swans, you disprove it by showing one black one.

    I’ll come back to this when i have more time…

  2. Hi Zoe

    You are perfectly correct to say that the sighting of one black swan immediately disproves the hypothesis that ‘all swans are white’. But I’m sure you’d agree that if we consistently saw 1000 white swans for every black one, we’d still be justified in saying that ‘most swans are white’. Science doesn’t deal in black-and-white; in true or false with nothing in between; but in a balance of probabilities from ‘highly unlikely’ at one end to ‘almost certain’ at the other. My concern is that horse owners are too ready to accept unsupported beliefs and testimonials as facts. Because many of these beliefs have become part of the culture of horse ownership, it is hard for people to find out that the rationale behind many of the alternative treatments (and I said ‘many’ here, not ‘all’) conflicts with what is known about basic science and the way the world really works. All I am doing is trying to make people aware that there are at least two sides to every convincing story – and my justification for doing so is entirely the good of the horse. If this means crossing swords occasionally with alternative therapists, well, that’s just the way it has to be. What I wrote is not ‘my personal version of the facts’, with nothing to back it up, but ‘the current consensus of expert opinion’, with links to some of those experts and their work. I put those links into my post because I think horse owners should be able to learn what is being thought and said about these matters, so that they can make up their own minds.

    I know that there are many books and articles supporting the various alternative treatments, but why should anyone assume that what those writers say is any more valid or true than what people like me say? Just because a lot of people believe something doesn’t make it true. At one time everybody thought the earth was flat: everybody was wrong.

    I’m more than happy to continue this discussion, though.

  3. Hi Alison,

    I’ve finally got time to write so here are my views:

    ‘How can you evaluate these claims, and sort out the facts from the fiction? And when does it matter? It matters most when it affects your horse’s health’ I agree it matters when it affects your horses health, but this can be in both +ve and –ve ways. I am not aware of any ‘alternative’ therapy causing harm when applied correctly. And fiction… could it not be that there just isn’t the science around to ‘prove’ it. Just because there is no science to prove it as fact, that doesn’t mean it has to be ruled as fiction.

    Yes in the UK any physical therapy is illegal unless you have vets permission, as the vet is ultimately responsible for the health of the animal.

    ‘Veterinary medicine is far from perfect, but “vets don’t know everything” doesn’t mean that they know nothing’ I agree with this statement, it is far from perfect. It is run majorly with the pharmaceutical industry (a multi-trillion pound industry). And as vets haven’t got the time to learn about all the drugs and the workings of the horse and all the alternative treatments this is where the individual practitioners come into their own. As they have had time to learn specifically about that therapy and its applications. ‘Vets don’t know everything’, you’re right and therefore by default its possible that some others know more than the vets in some areas e.g. these therapies and how they work etc. This is why I (as a therapist) consider them complementary and not alternative and that we all work as a team with the vet, farrier, chiro etc. No one of these can do everything and has all the knowledge. I also feel, having worked in an equine practice myself that there is an element of fear – what if there is no need for drugs and that nature has it all sorted – there would be no need for vets and no need for drugs (I’m not saying this is the case btw, just that there is an element of fear. And what we fear, we destroy i.e. evidence to prove these therapies don’t get published or the funding. Guess where the funding comes from – yes you guessed it, from the pharmaceutical industry and that would mean they risk not being able to sell their products – don’t underestimate the sheer power these drug companies have!!)

    ‘Scientific veterinary treatment is based on a thorough and well-established understanding of equine biology’ as what science can prove at the time, we are always finding gout more and there are always going to be things we never understand.

    ‘we know enough to be able to say with confidence that although some are more plausible than others, most alternative therapies cannot possibly work in the way that their proponents say they do’ how can you say this as fact when you just said we don’t know everything? And how do you know where to draw the line of where is ‘enough’?

    ‘So, that being the case, how is it that so many people swear and declare that therapy X “worked for them” and cured their cystitis, or backache, or their horse’s scabby skin, or whatever?’ ‘So that being the case then’ – when the previous sentence was your opinion – that’s a bit persuasive don’t you think? Is it not possible that it did cure them or is that a scary concept that we don’t need artificial drugs to ‘cure us’? How many people would you need to hear this from to say that it’s not a coincidence? I can bet my bottom dollar that the drug companies, when they are doing tests, don’t need many results (compared to the amount of people that swear by the old remedies) to conclude that it works and that it can go on the market as a cure for x, y and z.

    ‘The total evidence to date suggests that almost all alternative therapies “work” through placebo effects’ does this mean you have read all the evidence for and against to suggest this as fact? What evidence? Scientific? Well I take that with a pinch of salt as anyone who wants to prove it gets shut down and even if that wasn’t the case it could be that there isn’t the technology developed yet. Have you looked at anecdotal evidence? Again I raise the question how many would you need to see before the math’s says its so unlikely that its not a coincidence? I also have to say that with animals yes there might be slight human placebo in that they ‘feel better’ or have ‘more energy’. But what about the many cases that have a skin condition that goes or any other ‘measurable condition’ that goes? Is this just a coincidence too? How many would you need to see before you can conclude ‘most’ complementary therapies work?

    ‘alternative therapists do get called upon for the sort of low-grade, minor, irritating-but-not-life-threatening chronic conditions, aches and pains for which there really isn’t any treatment, either in horses or humans. Because many of these conditions do go away or improve on their own, the therapy is likely to get the credit’ I don’t understand how you can say that. First you say it’s a chronic condition (long standing) then in the next breath you say they clear up on their own, that happens to be in tandem with the therapy but that was just a coincidence!! The reason ‘alternative’ therapists, as you like to call them, get called out is because as you have just said, allopathic medicine can offer no cure so why get a huge call out fee for the vet to get there and say there is nothing they can do, when they can call a complementary therapist (who in turn phones the vet for permission) to give them some relief (in most cases)?

    ‘when the horse does have a serious condition and the owner, impressed by the apparent success of a therapy, calls the therapist to deal with something that really needs a vet’. Again – you need vet permission so this is an invalid statement. And if the owner is impressed with the ‘apparent’ success then who’s to say there is no success? Also any good therapist will, even after getting vet permission, recommend a vet comes out, if that’s what they see fit as it’s the vet that’s legally responsible for them.

    ‘Many commonly-accepted ideas in the horse world are based on unsupported belief rather than on biological reality. Too much nonsense has become mainstream in the horse world because too few people are willing or able to question what they are told’
    People just want results for the money they spend, they don’t really mind how it works, they want results – that’s how it spreads by word of mouth. What do you mean unsupported belief? The belief comes from somewhere – it’s from the results. So the results support the belief. Biological reality is only as good as the development of technology. ‘Too much nonsense’? in whose eyes? This is fear based IMO.

    ‘Anything – therapy, training method, supplement or feed – that uses the words ‘magic’ or ‘miracle’ or promises instant cures for chronic conditions or problems. These are not valid biological processes (Carroll 2009)’. AGREED – when dealing with nature you can never make promises. Most complementary therapist would agree I’m sure, that whatever the therapy it is they do, they would never preach it’s a magic wand. It’s the people ‘on the other side’ that put these words in peoples mouths (from my experience anyway).

    ‘Any therapy based on the idea of manipulating or rebalancing some sort of mysterious, undetectable ‘energy’ or vital force. Not only is there absolutely no convincing evidence whatsoever for any such force, there is no need to look for one: the clinically significant goings-on of the body are already perfectly well explained by processes and structures that are known and well understood’ This sounds fear based to me!! And this ‘energy’ is scientifically detectable. This is why acupuncture was poo-pooed for so long. Then they found this chi and now you can have acupuncture on the NHS (in some places). ‘Energy’-based therapies are generally survivals of ideas from a time when people didn’t know how bodies worked, and this was their best explanation in the absence of knowledge about blood circulation, the nervous system, microbiology and biochemistry’ I believe they have survived all this time because they actually work. I also believe people were far more in tune with nature and their bodies that they new this because they weren’t bogged down with science and logic!

    ‘Anything that claims to be safe and beneficial because it is natural. Many natural things, from virulently poisonous animals and plants to earthquakes and volcanoes, are extremely dangerous. Many synthetic substances, such as purified active ingredients in drugs, are safer than the raw plant materials from which they are derived’. Thank goodness for the multi-trillion pound pharmaceutical industry, how did we survive before they were about!? I agree that many natural things are harmful, but for as many harmful things there are I’m sure as dam-it there are as many if not more natural things that are good for you! Why are they derived from the plant in the first place? Is it because they work? But wait you can’t sell a plant or weed for near as much money as a few capsules of drug. The drug industry knows it and they are doing their best to shut it all down, again fear based.

    ‘Anything claiming to ‘boost the immune system’. This is scientifically meaningless, cannot be tested, and in any case there is nothing a normal and healthy animal (horse or person) can do to improve immune function (Crislip 2009). Indeed, would you want to? Many equine problems such as COPD and other allergies are the result of an overactive immune system, not a weak one’. It might be scientifically meaningless (I don’t know) but why then do they use this to sell their drugs? I don’t believe this to be true anyhow. Take the common cold some people get this every winter yet someone else in the same proximity doesn’t catch one. Is this not down to your immune system? And there is nothing you can do to improve it, what’s their definition of healthy anyway? This is not true, how about eating healthy – that will make you better able to fight off infection. If what you said was true then how does it work- if one person gets a cold one year then doesn’t the next even though they are around people who have a cold? Immune system me thinks! And take it to extremes to try and prove your flawed point won’t you! No you wouldn’t want an over-reactive immune system (with COPD and whatever) just like you don’t want an under-active one either. If a horse has a low one then yes you want to boost it, but if they have a high one then no of course you don’t want to boost it!

    ‘Funnily enough, anything that is advertised as ‘supported by science’. What this often means is ‘there are one or two weak, just-about-positive studies out of the thousands of negative ones that have been done’. Advertisers can almost guarantee that their readers will not look up the references to check, even if they are able to do so’. Are you saying this is fact and that you have researched it or is it your opinion? So ‘anything’ that’s supported by science you’re saying don’t trust?

    ‘Training methods based on the concepts of leadership, or dominance/submission, or the idea that a horse must respect his trainer before he can be trained. These ideas may be at odds with learning theory (Goodwin et al. 2008).’ Now that I do agree with!

    And from your reply:
    ‘(and I said ‘many’ here, not ‘all’)’ yes but in your original piece you said to quote ‘The total evidence to date suggests that almost all alternative therapies’

    ‘horse owners are too ready to accept unsupported beliefs and testimonials as facts’ unsupported on what grounds? – see above

    ‘All I am doing is trying to make people aware that there are at least two sides to every convincing story – and my justification for doing so is entirely the good of the horse’ 2 sides to me suggests balance. There is no balance that I can see in your article. Also you say for the good of the horse, is there any evidence to *prove* that these alternative therapies cause damage and harm (and therefore for the good of the horse)? Can you point me to them please?

    ‘the current consensus of expert opinion’’ – exactly, you said it, its expert opinion and therefore not fact (by definition).

    ‘I put those links into my post because I think horse owners should be able to learn what is being thought and said about these matters, so that they can make up their own minds.’ How can they make up their own minds when you’ve only put links to one side of the coin?

    I had to quote you so many times so I can keep track of my thoughts and so you can follow what I’m saying. I do think it’s important to have these discussions though as this is how you learn. I also believe you can’t just follow and believe anything because they have good sales tactics, say its natural or whatever – you should research it for yourself.

    I believe balance is the key, and I do strongly believe there is a place for both allopathic medicine and complementary medicine to work along side each other and neither one to have to fear the other.

  4. Hi Zoe

    I did get the impression that you were a therapist yourself and so are unlikely to be persuaded by my arguments – but for the benefit of all readers here are a few more observations based on your comments.

    When I said that veterinary medicine was far from perfect, I wasn’t referring just to veterinary drugs, but to veterinary knowledge. An alternative therapist might know more about the workings and application of her therapy than a vet does, but not all therapies are equal. If the therapy is based on scientific principles and actual biology, fair enough, but many therapies are based on New Age metaphysics or on outdated theories of health and disease – and any scientist would regard them as nonsense no matter how much the practitioner knows about them. A therapy where the practitioner has to have a reasonable standard of anatomical knowledge before training in it, and where the training is thorough, is one thing; a therapy – and there are one or two – where someone with no horse experience whatsoever can do a two-day course and then go out and practise on other people’s horses, for money, is something else entirely. Personally I would rather trust someone like a vet who has studied full-time for five years and who actually knows what goes on inside living bodies. Yes, they’re more expensive than therapists (who aren’t exactly free, either) but how much is your horse’s health and soundness worth?

    It is true that there is less money available for testing veterinary drugs than for human ones, and it is also true that veterinary trials tend to be smaller, not so well-designed, and often funded by people with a vested interest in the outcome such as pharmaceutical companies, as you say. But it’s a big jump to say that pharmaceutical companies are suppressing or not funding research into alternative treatments as that simply isn’t true. These therapies are being tested all the time – mostly in people, admittedly – and in many cases with taxpayers’ money. Positive results are published as well as negative ones. Indeed, many countries have a reputation for publishing only the positive ones. But in the US, the National Centre for Complementary and Alternative Medicine has spent $2.5 billion of taxpayers’ money and 10 years researching alternative therapies, without finding a single definitive case of a therapy working better than placebo. And these are people who really, really want to prove that the therapies work.

    When I say that the current evidence suggests that almost all therapies work by the placebo effect, of course I haven’t read every paper on the subject. Nobody has. But there are enough people reading and reviewing various parts of the evidence and setting the findings into the context of what is already known to be true, that this has come to be the scientific consensus. There are some positive studies for many therapies, even the most unlikely ones. But there are also negative ones, and what people have found is that the larger and better-designed the study, the more the effect of the therapy is indistinguishable from placebo. That isn’t to say that nothing happens – the placebo effect is a real effect – but that what happens, happens for a reason other than the presumed mode of action of the therapy.

    I said that although we don’t know everything, we do know enough to say that some alternative therapies are based on implausible ideas. It’s because of basic scientific studies into the way things work. It’s like the way we would say that because of what we know about gravity and the way it acts on mass, the idea that a person who jumped off a cliff would float about in mid-air is implausible.

    Anecdotes – people saying that they tried Therapy X and their Condition Y went away – aren’t evidence. A million such stories wouldn’t be proof that something worked. The vets I’ve spoken to reckon that 75-80% of all the things that afflict horses will eventually go away on their own. That includes chronic conditions (which are long-lasting, but not necessarily permanent). So yes, it is more than likely to be coincidence if you try X and Y goes away. It might suggest that X cures Y but it doesn’t prove it. Y could have gone because it was going to get better on its own anyway. People tend to feel better when they take a positive step to improve their health, and when they spend time with a caring and sympathetic therapist. They are likely to project these positive feelings onto their horses whether the horse actually improves or not. The therapist might have suggested a number of other things, any one of which could have caused the improvement. The horse with scabby skin belonged to someone I know. The therapist did her therapy. But she also advised the owner to take all the sugar out of the horse’s diet, avoid washing his rugs in biological detergent and give him more turnout time, and the vet had prescribed antihistamines and an antibacterial shampoo. The owner declared it was the therapy that did the trick, but with all those other things going on at the same time, how could she possibly know? That’s why scientific testing really is the only way to find out – it eliminates all the variables except the one you are testing. We really do have to have the humility to say that experience isn’t enough, that we could be wrong, and that there might be a different explanation for what we see.

    Therapists like yourself obviously work with vets and everything is transparent and above board. Not everybody acts as ethically or legally. Some therapists telephone the vet and ask for permission to work on a horse. Others expect the owner to do this and as long as the owner signs a form to say that they have asked their vet, the practitioner is covered by her insurance. The owner may not have actually asked the vet, for a variety of reasons. One is that the vet might insist on seeing the horse first, and the owner doesn’t want to pay for that as well as for the therapy. Another is that she wants the horse to have the therapy, and suspects that the vet might say no. I have heard both reasons from horse owners.

    The Veterinary Act of 1966 states that the manipulative or physical therapies are the only ones a non-vet may perform on other people’s animals, and only if given permission by the vet who must first give a diagnosis. Everything else, from homeopathy and aromatherapy to reiki and crystal healing, is illegal unless done by a vet trained in that therapy. A surprising number of people aren’t aware of this – including some physical therapists who do know that they need veterinary permission to do their primary therapy.

    A person who is trained in a physical alternative therapy will often believe that all alternative therapies are equally useful and valid, and that they can be used together, and so when the owner of the horse she is treating asks if there is anything else that might help the horse, the therapist is more than likely to recommend aromatherapy, or homeopathy, or a herbal remedy, or anything else she happens to know a bit about. This is not legal. It happens. There are also people who use questionable techniques to diagnose problems and then prescribe alternative remedies on the basis of their diagnosis. This is illegal. It happens. It is accepted without question by horse owners who have come to believe in the alternative therapies. Essentially there is a black market in horse medicine going on, where horses are being diagnosed and given treatment by people who are neither qualified nor allowed to do so.

    Do alternative therapies cause harm to horses? As far as I can see there isn’t any systematic source of information about damage caused to animals, though there is plenty for humans – at http://www.whatstheharm.net. Extrapolating from people to animals, the possibilities are injuries to muscles and joints from physical manipulation (even if the practitioner is doing everything properly the horse could still pull back or move at the wrong moment and delayed onset muscle soreness can also occur); overdosing of vitamins and mineral supplements; allergic reactions to aromatherapy oils; poisoning from herbal remedies; therapists advising owners not to vaccinate (have you ever seen a horse with tetanus? Not a good way to die). However, as I’ve said before, the main danger is not in direct harm but in the therapist not having the knowledge or training to recognise when the horse has a condition that needs veterinary attention. And it does happen.

    No, ‘energy’ as in the sense of ‘chi’, isn’t scientifically detectable. It’s never been convincingly and repeatably demonstrated. Even the practitioners of ‘energy’ healing methods say that it’s too subtle to be detected by mere machines – only by the hands of a trained practitioner. But biologists know that all bodily processes are explainable by the forces we already know about and can measure, and physicists know that if there was some sort of extra energy lurking about, it would affect the relationships between predictions and experiments in a way that doesn’t happen. And experiments on the energy therapies have also suggested that there is no need to invoke ‘energy’ to explain what is going on.

    Just because something has lasted for a long time doesn’t mean it works. People in Europe believed for a couple of thousand years that bloodletting and purging were effective treatments. They weren’t.

    How did we survive before the pharmaceutical industry? Many of us didn’t. The rise of science-based medicine over the last 150 years has been responsible for more improvements in lifespan and health than any of the previous millenia of traditional treatments. For horses as well as humans. Yes, the pharmaceutical industry, like all businesses, is out to make a profit (even in the UK the alternative medicine industry is worth £1 billion a year), but I don’t think anyone would want to go back to the bad old days when there were no effective drugs for many conditions. Perhaps the problem is that we’ve collectively forgotten what it was like, for instance in the days before antibiotics when vets had no choice but to watch animals die from common infections that are now easy to treat.

    I’m not an expert on immune systems either, which is why I referred readers to Mark Crislip’s article.

    I know – because I have tried it – that scientific references quoted by advertisers are in some cases impossible to look up because they are in internet journals you have to pay to read; in other cases they don’t actually say what the manufacturers say they do; and in some cases there are some promising early studies (these are the ones quoted) that have since been discounted by more rigorous tests.

    When I say ‘unsupported belief’, I mean the belief that personal experience makes objective testing unnecessary, and that the results of objective tests, if negative, will make no difference to a person’s belief in what he or she already ‘knows’ to be true. The important question to ask is, “what would make me change my mind about whether therapy X works or not?”, and if the answer is “nothing”, it’s a belief, based on faith rather than on facts.

    Actually, one of the things that really interests me is why people are inclined to have these beliefs about health when they are much more hard-headed and rational in other aspects of their lives. For instance, if someone tried to sell them a car, saying that it had no engine or brakes but worked by a form of subtle energy that was activated by them holding the steering wheel in a special way, they would raise their eyebrows and take their money elsewhere. But if somebody said she could cure their horse’s lameness or allergy using a similar system, they’d try it. Why?

    I don’t know why you think I am afraid of the idea that horses can recover without drugs or surgery: I know they can. I’m not afraid of mysterious forces, either. I am not a vet or a therapist and have no vested interest in any of this. And as for presenting a balanced argument, I am the balance. In the last couple of decades I have not seen a single article in a horse book, magazine or website questioning any alternative practice. It is all uncritically accepted and promoted. I am writing these pieces not because I expect or hope to convert any true believers to a more critical way of thinking, but because I think that horse owners deserve to see both sides of the story. And because I think truth is important even if it isn’t always what we want.

  5. Excellent article, and very clear and pursuasive. It is telling that the arguments against your position frequently involve several common points. See if you can spot the theme running through them.

    1) What we don’t know implies that we cannot fairly question any claim because it might be one whose proof falls into the are of knowledge we lack. This, of course, ignores the fact that many alternative methods are based on principles (ch’i, vertebral subluxations, water memory, etc) which can only be true if much of what we do know through science is actually wrong. This approach to knowledge can limp along when it sticks to vague, chronic disease, but there is a reason homeopathic birth control, reiki for gunshot wounds, and alternative theories of aviation and airplane design don’t show up very often. When the principles we know to a high degree of probability from science are balanced against the vague, we-can’t-absolutely-prove-it-isn’t-true ideas behind most alternative therapies in situations where the right answer is crucial, science justifies its approach but manifestly working bettter.

    2) The reason alternative therapies lack good evidence is either that they aren’t studied because shadowy conspiracies, usually involving the pharmaceutical industry, prevent it or because they are phenomena whose very natural is not subject to empirical study. That is why they deserve the name of faith-based medicine. You can, of course, believe whatever you like, but if you canot prove it because the only possible evidence is your own intuition or revelation, than it is religion. And history suggests that theology makes for far less reliable a foundation for medical care than science. Antibiotics cure infections whether you believe in them or not, but casting out demons (or in today’s terms, balancing one’s energy) only makes you feel better if you believe in it, and even then it doesn’t stop the infection from progressing.

    3)If lots of people have believed in something for a long time, it must be true somehow. Te evidence of history is unequivocal in demonstrating that this is nonsense, of course. Bleeding, purging, exorcism, animal sacrifice, and a thousand other popular and enduring bad ideas in medicine have come and gone without a meaningful change in the quality of length of human life that even begins to approach that which science has brought about in a couple of centuries. Yet even so, people are incredulous at the idea that so many could be so wrong for so long, and they persist in believing that belief itself can be evidence for its own claims.

    So far, we have argumentum ad ignoratium (what we don’t know proves we can’t say we know anything), ad hominem (if Big Pharma is behind it, it must be bad), and ad populum (lots of people can’t be wrong). The common thread I see is that none of these points deal with the actual facts or evidence or even the fundamental logic of scientific medicine and your critique of alternative medicine. They are all ways of dismissig your arguments without addressing them and substitting the fith believes of the person speaker for facts. The very style of argument, it seems to me, reveals the weakness of the underlying epistemology and the crucial difference between science-based and faith-based medicine.

  6. Oh what a timely and thoughful contribution to this vexed field, Alison – many congratulations. I look forward to further reading here.

  7. I did feel the article was biased and one dimensional. It did not attract me to science, I seek attraction rather than promotion, good points to discuss though.

    I found Dr Bruce Lipton’s book ‘The Biology Of Belief’ very balancing. I dont think we should rely on science as our only benchmark.

  8. Sarah:
    I would agree the article was biased, biased towards reality that is.

    “I seek attraction rather than promotion” = word salad.

    Sheesh.

    Good article Alison! I see so many horses that come in months and months after the intial injury after the owner has gotten everyone else involved but their vet. The treatment generally is much more expensive and prolonged than if they had come to us first of all. That’s the harm of alternative therapies.

  9. Just a few more thoughts…

    Placebo is very real as you said which means the power of our minds are incredible and can heal ourselves purely by thought alone. I find it strange that placebo is thought of as being a negative thing when really its such a positive thing. Imagine if we went to a doctor who just said ‘believe you will be better and you will get better’.

    ‘I said that although we don’t know everything, we do know enough to say that some alternative therapies are based on implausible ideas. It’s because of basic scientific studies into the way things work’ i can see what you’re saying here but i’ve known science to do a complete u-turn i.e. previous science has been proved completely wrong, meaning to say that it all depends on the technology at the time.

    ‘Anecdotes – people saying that they tried Therapy X and their Condition Y went away – aren’t evidence. A million such stories wouldn’t be proof that something worked.’ Yes i see what you mean by it not being scientific evidence – i guess that’s down to the individual to decide if they need science to have proved it to make a choice. I don’t believe it’s ‘more than likely a coincidence’ though. I mean i’m no good at maths and working out probablility but i’m sure with the amount of anecdotes there are, the probability of it being coincidence is so unlikely, and that it was the therapy that helped. I do hear what you’re saying though in that it doesn’t *prove* the therapy, but it’s obviously good enough for many.

    ‘The therapist did her therapy. But she also advised the owner to take all the sugar out of the horse’s diet, avoid washing his rugs in biological detergent and give him more turnout time’ See I see this as *part* of the therapy (i do hear what you’re saying though re it doesn’t *prove* the therapy) particularly if its a holistic therapy-treating the whole and not just the symptoms. But this is the same as a vet telling the owner of a laminitic to put it on a deep bed and feed only hay – it’s *part* of the treatment for the horse. And in many holistic therapies are treating mind, body and soul (which i believe are interconnected).

    With regards to them doing harm – i don’t see overdosing with vitamins and herbal poisoning and the like as the therapy being correctly given and therfore i don’t feel it’s fair to use them as examples. However i’m not buring my head in the sand, there probably are cases where everyting is done correctly and there has been a reaction. But in the same light, many drugs have terrible side affects but that is just accepted as the norm and ok. I’ve read sources that say doctors are the third biggest killer in the US (after heart disease and cancer) – and thats correctly prescribed drugs. So between us all it’s just a case of doing the best we can.

    ‘But biologists know that all bodily processes are explainable by the forces we already know about and can measure, and physicists know that if there was some sort of extra energy lurking about, it would affect the relationships between predictions and experiments’ There are going to always be things about the workings of our body that we will never know and understand. And affecting results – i thought thats what quantum physics is able to explain. Also just to add that scientifically it is impossible for the bumble bee to be able to fly – but it does. Again just to show we can’t *imo* go on science alone.

    I suppose ultimately it depends what you read to get your info. I suggest Bruce Lipton also, Lynne McTaggart, Masaru Emoto etc.

  10. I’ve never said that the placebo effect was negative – because it isn’t. I used the term ‘placebo’ in my article in the very broadest sense of ‘everything that happens in a therapy session other than the active ingredient of the treatment itself, that results in the person feeling better’. So it does include the time and attention and concern shown by the therapist, and the opportunity to talk about all sorts of things with a sympathetic listener, as well as the ritual or procedure of the treatment itself. And it happens in all medical interventions, not just alternative ones. Something like 35% of people are affected on average, and in some situations almost everyone is to some degree. It happens exactly because we are so suggestible. That isn’t because we are stupid. It’s because we are human and that is how our brains work.

    I guess people are drawn to the alternative therapies because they find belief, and cultural values, and perhaps a bit of mystery, and an appeal to their spiritual selves, and the testimonials of their friends, more persuasive than objective evidence of whether something actually works or not. There’s no doubt that those people benefit from the psychological effect of the whole experience, but that isn’t the same as being cured because there’s still no compelling evidence that alternative therapies have much, if any, effect on the progress of actual medical conditions, as opposed to people’s perceptions of those conditions. Sure, sometimes things do get better after a visit to a therapist, but as I’ve pointed out before, you can’t make reliable generalisations about cause and effect simply because one event followed another – you have to do objective tests before you can tell if there’s a real relationship and you have to consider whether it’s even possible that event A could cause event B. As an example that I wish I’d thought of – there’s a strong correlation between getting breast cancer and wearing skirts – but would you therefore assume that skirt-wearing can cause breast cancer? Is it even possible?

    I’m not at all sure that we can heal ourselves by thought alone, despite what some New Age gurus would have us believe, but we can certainly feel better by thought alone, and it’s well known that our perception of symptoms such as pain, nausea, depression, anxiety and so on can change very quickly and easily. The power of human psychology is pretty staggering. But really that’s my whole point – and why I wrote the article – alternative therapies make people feel better because they are PEOPLE. It’s a big jump to assume that they will make horses feel better too.

    Lots and lots of people like the whole alternative therapy ethos of treating the body, mind and spirit and imagine that their horses are going to like it too. They seem to think (and this is from talking to owners) that their horses will appreciate what they appreciate, for the same reasons. They think, for instance, that because they enjoy a physical therapy, their horse will find it lovely too. Or that because it changed their perception of pain, it will stop their horse hurting. They suppose that because they find some therapy spiritually uplifting, their horse will do so as well. They even talk about their animals as spiritual beings and make all sorts of speculative pronouncements about their psychological states, emotions, motives and ideas. Now although the workings of the human brain does give us a totally convincing feeling that we have minds and spirits that are somehow independent of our material selves, there is absolutely no justification at all for assuming that a horse feels the same, and just because he has emotions that we recognise and respond to, and behaviour that we (mostly) understand, doesn’t give us in any way the right to assume that we know anything at all about his actual perception and interpretation of himself and the world. Being a horse could well be unimaginably different from being a person and probably is. So it doesn’t seem right to assume that therapies that a human finds satisfying should also seem so to a horse – especially since there is so little evidence that they work other than psychologically, on human minds. Though I would add that from what I have seen, horses who enjoy physical therapies (and not all of them do), do seem to find them relaxing and they may make horses feel better in the short term, as they do people. But feeling better in the short term is not the same as being fixed and that’s why vets such as MaxH who commented above (thanks Max) are concerned about owners turning to alternative therapists as a first step. Which they do sometimes, as we all know.

    Changes in scientific opinion – yes, it happens all the time and it’s meant to. That’s how science works, and it’s one of the things that sets it apart from some of the alternative therapies that never change, regardless of new evidence coming in. But for some therapies to work as they are said to work would not mean a change of opinion in one field of science but in the whole lot – everything that has been established about the way the natural world works over the last several hundred years. It’s not impossible but it is vanishingly unlikely.

    Science isn’t always appropriate when making choices or deciding whether something is worth having or doing – personal opinion is far more valid when it comes to choosing a partner, for example, or when assessing art or poetry or music. But it’s different for things like medicine, or engineering, or aeroplane design, when there are facts that matter, regardless of our opinions or preferences.

    BTW the one about bumble bees being theoretically unable to fly is an urban myth that seems to have been based on somebody extrapolating from the aerodynamics of aeroplanes to something bee-sized. It’s not serious science. As for the serious science of quantum physics, yes, stuff at the scale of sub-atomic particles is unimaginably different from everything in our normal experience, but the predictions it makes and the results people get are more reliable and repeatable than in any other scientific field. There simply aren’t unexplained results that suggest the existence of mysterious forms of energy with therapeutic powers. (www.colorado.edu/philosophy/vstenger/medicine/physCAM.pdf is a good explanation of all this.)

    And a note about bias, for those readers who felt my article was biased. If it had been an uncritical, totally enthusiastic promotion of alternative therapies, with not a word about the scientific research suggesting they might not actually work, would you have thought that was biased? Just a thought.

  11. Great comment Alison. I would also like to point at that despite Zoe’s assertation, the scientific establishment very rarely makes ‘complete u-turns’. In fact I can’t think of any scientific theory that spent hundreds of years being established and then being proved to be completely wrong!

    It’s true scientists do change their minds, but these are generally little changes, additions, subtractions or tweaks to current knowledge; constantly homing in on the truth. To quote The Big Bang Theory: Calling a tomato a vegetable is a little wrong, calling it a suspension bridge is very wrong.

    And Alison, I’m not a vet alas, just a mere tech!

  12. No need to be rude Max, who define’s reality, you?

    Re word salad, what do you mean?

    Forgive me if opinions are not welcome here.

  13. Max, i think you mis-understood what i meant when i said ‘complete u-turns’. I wasn’t refering to theories (although that word itself means just that – they are theories). Take for example asprin. We were told one-a-day is good for you, then a while back (probably more than a year knowing how quickly time flies) they turned around and said actually taking an asprin a day isn’t good for you and may make you more likely to get x,y and z.

    That was all i was meant. Meaning to say that if we went on just science it may get proved wrong further down the line. So in Sarah’s words i don’t feel science can be our *only* benchmark.

  14. Sarah:

    I’m sorry if you were offended by my slightly ascerbic tone, I did assume we were all adults here. Of course you may have opinions, you have every right to your opinion. And I have every right to mine. And it’s NOT rudeness to disagree with you. RE: reality. We can all observe and measure reality. It is reality that gravity exists, that the earth is spheroid and that due to a very thorough vaccination programme, smallpox has been eradicated. If you don’t like this reality then feel free to float up into the sky but please forgive me for not following you. RE: word salad. I simply meant that your comment “I seek attraction rather than promotion” does not make sense.

    Zoe W: But the scientific method is the most reliable and thorough way of testing that we have. “It worked for me”, while positive in your own case (obviously) does not mean that it will work for me. And when I pay money for a service/drug/etc then I damn well want evidence that it WILL work for me! Evidence that has been proven and published so anyone else can look at the study and see for themselves what has been done. Aspirin, despite whether or not it is recommended to stave off heart attacks, is still a proven analgesic. Scientific theories aren’t theories as how a layperson might use the word, such as ‘idea’. In science, and idea is a hypothesis, which then gets testing, rigorously, again and again until it enshrined as a theory. After all, the theory of gravity is a theory, and if you think that means that it can be ignored because you don’t like being earhtbound, or don’t understand the science; then I suggest you float up with Sarah. Though once again, I will not be joining you!