The practice of equine medicine is undergoing enormous flux. There are pressures to employ digital technology, telemedicine, distance learning, Internet consulting, and to purchase new devices. At the same, "traditional equine practice" is being challenged on another front – by the practice of "alternative medicine."
The 2000 American Association of Equine Practitioners (AAEP) meeting saw the first major lectures on alternative medicine in the association's history. Topics in alternative medicine were reviewed by Dr. Allan Schoen (acupuncturist) and Dr. David Haussler, Cornell University (chiropractic). The lectures emphasized the integration of alternative medicine into traditional practice, and not its sole use in veterinary care. Indeed, the phrase "complementary medicine" has been coined to describe this integrated approach.
Despite the attempts to merge alternative medicine with more traditional practices under the guise of "complementary medicine," there was still a clear lack of consensus among veterinarians concerning this approach. There was a tremendous amount of discussion generated among the members. Some members have "thrown out the baby with the bath water," practicing only alternative medicine. The methods of acupuncture and chiropractic appear compelling to these individuals. They see good results, satisfied customers, and develop a more comfortable lifestyle. After all, there are few "alternative emergencies." Others employ alternative methods as an adjunct to traditional practice, unwilling to make the complete plunge – this combined practice is referred to as "complementary medicine."
The Rush Towards "Alternative Medicine"
Equine clients demand what traditional equine veterinarians cannot always provide: early diagnosis of rider/trainer perceived problems in lameness or other areas of concern.
"Traditional" lameness examination, for example, is considered an art and highly skilled practice when performed by an experienced veterinarian. It is performed systematically by using careful palpation of the limbs, flexion tests, repeated observations of movement, response to hoof testers, diagnostic anesthesia (nerve blocks), X-rays, ultrasound and other methods. Most lameness can be precisely diagnosed using these methods.
However, anyone in equine practice knows that it is not possible to localize the cause of lameness in 100 percent of the cases, especially in cases of "rider felt" subtle lameness. Hind limb lameness is especially difficult to sort out, especially if they cannot be blocked out. Much lameness involves soft tissue structures that defy localization, since most traditional methods focus on joint, ligament, and tendon abnormalities of the limbs. Painful areas in the large muscle mass of the hindquarters, neck, and back, are not amenable to localization using traditional methods in many cases.
In traditional practice scenario, there is the option of referring the case to a hospital, which utilizes more sensitive techniques such as nuclear scintigraphy, CT and MRI. The intent of developing these sophisticated methods in large part was early detection. However, specialists in referral hospitals are more often asked to examine complex, multiple joint lameness that is nagging and severe. The reason why early subtle lameness is not routinely referred to a large animal hospital has to do with the fact that many of these lameness cases can be diagnosed in the field or get better on their own. Clients are also reluctant to transport a horse, pay the high cost of these procedures, and find it difficult to put a face on an institutional practice.
Therefore, it should come to no surprise that a large niche has evolved to address the very subtle, early lameness and other problems perceived by the experienced rider or trainer. The niche is for early diagnosis, using non-invasive, non-painful methods, without the requirement of sedation or anesthesia, administered at a reasonable cost, on the farm, which can additionally supply symptomatic relief. This is a tall order for any diagnostic/therapeutic modality, but clearly the public demands it.
Alternative therapies are attempting to fill that niche, which is already extremely popular amongst human athletes. Examples of techniques include acupuncture, chiropractic, massage, and physical therapy. Individuals certified to perform these methods are growing rapidly in numbers. They have built tremendous practices using alternative methods. In part their success can be attributed to filling this niche, and that "alternative veterinarians" listen well to their clients.
All Equine Veterinarians Don't Agree
Polarity has developed over the issue of alternative medicine in equine practice. Many veterinarians, while frustrated over the difficulty to diagnosis certain lameness and other problems using conventional methods, are not ready to jump on the bandwagon. This is not unique to the healthy skepticism that still surrounds alternative human medicine. What are the scientific principles behind any modality?
The skeptics, while open-minded about many things, want the answers to some or all of the following questions before adopting alternative methods in their practice:
What is the evidence that alternative medicine practices are efficacious in specific disease problems?
Can alternative veterinarians actually make diagnoses that traditional veterinarians cannot? If so, are there any studies that demonstrate this to be true?
Is it possible that alternative medicine practices, however non-invasive, are harmful, for example by delaying traditional, proven methods of diagnosis?
How should consumers be informed about alternative medicine practices?
How should consumers be charged for alternative procedures?
How should alternative procedures be scientifically investigated? Can the effects of alternative procedures only be measured using alternative practices?
Why should alternative medicine be under more scrutiny than other trial and error procedures that are used in practice?
Why is alternative medicine under fire to a greater extent than other experimental practices that are currently being employed to the benefit of clients? Indeed, the AAEP fosters the introduction of experimental procedures by permitting presenters to discuss preliminary results, prior to peer-review. This has been the best way to keep members up to date, but some procedures discussed never make it to the market or are unpublished. They are clearly experimental and stimulate tremendous interest and application in the field. Clearly, alternative medicine, has drawn more attention, perhaps unfairly, for several reasons:
The widespread use and enormous expenditures of owners on alternative medicine.
The lack of published research in horses on efficacy.
The appearance of alternative veterinary practice acting as a substitute for traditional methods in some cases.
The complex, time-consuming, and expensive process of certification.
Alternative medicine may symbolize a shift in the "way of life" of the equine practitioner, which may be hard for conservatives to accept.
For these reasons alone, alternative medicine has been more closely scrutinized in the world of skeptics than other experimental modalities that have not enjoyed (for better or worse) such widespread popularity.