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Homeopathy Group Sues Over Denial Of CE Credit

Denial of CE credit leads to lawsuit by Homeopathy Group

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The Academy of Veterinary Homeopathy is suing the American Association of Veterinary State Boards, claiming breach of contract and fraud in relation to the association’s refusal to grant continuing education credits for classes at its 2009 annual conference. 

At issue is AAVSB’s RACE standard requiring evidence-based support.

The Academy of Veterinary Homeopathy is suing the American Association of Veterinary State Boards, claiming breach of contract and fraud in relation to the association’s refusal to grant continuing education credits for classes at its 2009 annual conference.

The suit was filed in January in Virginia state court. AVH recently provided details.

The association’s Registry of Approved Continuing Education, or RACE, is a national clearinghouse for the approval of continuing education providers and their programs, according to the AAVSB website, aavsb.org. 

AVH contends that no one on the RACE committee or within its group of paid consultants has experience with or knowledge of homeopathic veterinary medicine. As a result, AVH  maintains that the value of homeopathy cannot be appropriately evaluated by the group.
After the Academy of Veterinary Homeopathy’s 2009 annual conference, AAVSB notified it that its offerings had not been approved for continuing education credit.

Some History

In the fall of 2009, RACE changed its standards to require that all scientific information used in RACE program applications in support or justification of an animal-care recommendation must conform to “the medically accepted and scientifically supported standards of experimental design, data collection and analysis.”

Practically speaking, alternative practitioners say, this means CE credit will not be granted to veterinarians seeking renewal of licensure through homeopathic courses that do not provide scientific evidence that meets RACE standards.

“AAVSB had no intention of approving AVH continuing education programs prior to inviting and accepting AVH’s provider renewal application in March 2009,” says Sidney H. Storozum, DVM, JD, who is certified in homeopathic veterinary medicine.

“The new language permits the RACE reviewer to pass judgment on the safety and efficacy of an entire treatment modality, with no requirement of input from qualified experts. Furthermore, RACE is overstepping its mission by being judge, jury and executioner of what passes as good medicine and what does not.”

AAVSB representatives had decided to not comment about the lawsuit on the advice of attorneys.

But last year, when asked about the change in standards, Robyn Kendrick, executive director of AAVSB, declined to comment. “Our attorney recommended we not dialogue about the RACE program at this time,” she said.

Kendrick did, however, send information explaining that the most recent update to the standards addressed the concerns of AAVSB member boards by ensuring that scientific programs approved by RACE were based upon the foundational, evidence-based material presented in accredited schools or colleges of veterinary medicine.

Dr. Storozum, a Virginia-based attorney, initially was lead representation for the AVH lawsuit, but after AAVSB suggested he had a conflict of interest, Storozum stepped aside and James Stringfield, JD, took over.

“AVH hopes to recover financial losses, but we also are willing to negotiate a reconciliation if AAVSB will adopt clear standards that permit complementary and alternative veterinary medicine providers to offer RACE-approved programs, where those programs have been reviewed by qualified experts in the respective CAVM fields,” Storozum says.

“There are three pending motions to be heard. After these are resolved, the next phase of the pre-trial process is discovery, which may include, among other methods, interrogatories, depositions and document production.”

At press time, a trial date had not been assigned.

“RACE approved similar AVH programs in homeopathy and has honored its provider agreement with AVH since 2000, before the 2009 policy change,” says Nancy Scanlan, DVM, MSFP, CVA, acting executive director of the American Holistic Veterinary Medical Association.

“AAVSB says homeopathy is not currently taught in accredited colleges or schools of veterinary medicine, and the revised standards require a program to build upon or refresh the participant in the standards for practice and courses as found in the curriculum of accredited colleges of veterinary medicine or accredited veterinary technician programs.”

The major change disallowing CE that had previously been permitted wasn’t noticed until veterinarians practicing complementary and alternative veterinary medicine, or CAVM, were denied CE credit and started speaking out. Some state boards are permitting CE for RACE-rejected courses.

Popular Modalities

Veterinarians who practice CAVM and Traditional Chinese Veterinary Medicine (TCVM) and those who combine complementary and alternative methods with conventional veterinary medicine (integrative veterinary medicine) say that to deny credit for these courses could mean the dissolution of these modalities.

“The primary concern is that this lack of RACE approval will deter veterinarians from investigating holistic medical approaches,” says Susan G. Wynn, DVM, of Georgia Veterinary Specialists in Sandy Springs, Ga.

“More than a third of the American public seeks out complementary and alternative medicine, and over half the American public owns pets. If a veterinarian has to choose between state or regional meetings to obtain required CE hours vs. unapproved CE in CAVM, veterinarians may be forced to forgo CAVM training or CE to improve on that training,” Wynn says.

“The growth of veterinary medical science is led by policy, partly established by RACE,” says Signe Beebe, DVM, CVA, CVCH, CVTP, of the Integrative Veterinary Center in Sacramento, Calif.

“As a leading force in the field, RACE has the opportunity and mission to not only exclude but direct the path of CE. In this time of novel results, [RACE] may be viewed as a navigator of new techniques.

“The decision to restrict or deny CE for CAVM can be projected to have long-term negative consequences on the veterinary profession as a whole. The public is demanding CAVM services for its pets. If we, the veterinary profession, do not provide educated, trained CAVM practitioners to fill this demand, then non-veterinary CAM practitioners will be more than happy to step in to provide these services.
 
“In other words we will end up losing our clients to the human CAM providers who have no formal training in veterinary medicine and exposing their pets to significant potential harm.”

CAVM ‘Endangered’

The propagation of CAVM is endangered, Dr. Scanlan says, labeling these changes an attack on veterinary medicine.

“RACE’s decision implies inferior education, which AHVMA totally disagrees with,” Scanlan says.

“We believe our CE is actually superior to some Western CE that has been RACE-approved. When we tried to contact RACE [to find out why credit was not allowed], we were told that RACE and AAVSB are only interested in talking to their constituents, the individual state boards. This means we are guessing at why they are not accepting our CE, and that it is impossible for us to change our course or lecture to make it acceptable.”
Critics of integrative veterinary medicine have spoken out in response the AVH lawsuit, saying a veterinarian’s job is to protect the public through use of his or her education and integrative medicine “isn’t science.”

“It doesn’t make sense to allow non-science-based CE hours to support a veterinarian’s license,” says Brennen McKenzie, MA, VMD, of Adobe Animal Hospital in Los Altos, Calif., the creator of the SkeptVet blog.

“Alternative medicine providers are often better at treating psychological aspects of a medical incident an owner is dealing with, and there’s no doubt they are caring and compassionate, but it’s just not scientific. This lawsuit is just a way for AVH to sway RACE to approving CE without proving their medicine through science. This is a marginal approach to veterinary medicine and these therapies are not taught in veterinary schools.”

Several colleges of veterinary medicine offer elective courses in CAVM or integrative veterinary medicine, including Washington State University, The Ohio State University, the University of Florida and Colorado State University. The Universities of Tennessee and Minnesota offer integrated services for clients. The majority of veterinary schools in the United States also offer holistic or integrative veterinary medicine clubs for students interested in CAVM modalities.

RACE standards say RACE providers must present activities that promote recommendations, treatment or manners of practicing veterinary medicine that are within the definition of RACE-approved CE as part of AAVSB’s public protection mission.

The RACE standards’ Section 5.02, Conflict of Interest Policy, states that CE providers are responsible for identifying content as promotional at the time of application and include the promotional subject matter on the certificate of attendance. Failure to comply with this policy jeopardizes the provider’s status as a RACE-approved provider.

“Some veterinarians who work for pet food companies and lecture on clinical nutrition and dietary strategies may fall into this category as well,” Dr. Wynn says. “I wonder if they have undergone the same scrutiny.”

Demand on the Rise

Over the last 10 years there has been an increasing demand for CAVM modalities for pets by the public, Dr. Beebe says.

“The demand for CAVM has largely been fueled by the development of CAM in human medicine,” she says.

“More than 85 percent of all human medical schools offer CAM or integrative medicine courses or have a department for these modalities. As more people use CAM therapies with good results, a corresponding increase in demand for CAVM therapies to treat family pets has been witnessed.
“Telling clients that there is not enough evidence or science behind CAVM therapies to recommend their use will not stop the public from requesting and using CAVM because of their direct positive experience using these modalities.”

AVH members say alternative medicine offers comfort to pets whose owners do not believe in using pharmaceuticals if there is another option. Others are disenchanted with the side effects found in some Western drugs.

“The success of Western medicine isn’t in question in many areas,” Wynn says. “However, it is in question in chronic diseases that are not easily resolved with conventional therapies.

“In some of these cases, long-term administration of steroids, NSAIDS or multiple antibiotics may be harmful. In these cases, suppressing the use of CAVM therapy because of the absence of an evidence base is not in keeping with the veterinarian’s oath.”
Holistic veterinarians point out that the Animal Medicinal Drug Use Clarification Act allows veterinarians to prescribe an FDA-approved veterinary or human drug to treat a condition other than the one that led to the drug’s approval in the first place. They say this would categorize these uses as non-evidence based.

Call for Evidence

“There’s a difference in the way CAVM therapies were developed compared with traditional veterinary medicine and RACE isn’t accepting the science that AVH presents,” says Shelley Epstein, VMD, of Wilmington Animal Hospital in Wilmington, Del.

“Integrated medicine now has more than 2,000 proven substances, and although there are no homeopathic veterinarians on the committee helping to make these decisions on CE for AVH [and therefore they don’t understand this science], we are simply denied the right to approved CE.”

AHVMA representatives maintain that to discredit CAVM is wrong and the RACE committee should be open to discussion instead of creating standards to cast a doubt on holistic medication and those who use it in practice.

“The word ‘scientific’ can be defined in different ways,” Dr. Epstein says. “The conventional world needs multiple trials to speak their language. They aren’t as critical of their own modalities as they are ours. If someone says a surgery didn’t work for them, most don’t assume the surgery won’t work for anyone, but if an integrative therapy doesn’t work on every patient, it means it’s useless [to non-CAVM subscribers].”

CAVM veterinarians say administering subcutaneous fluids for chronic renal disease or prescribing these fluids for owners to administer at home to patients with chronic renal disease is practicing and promoting non-evidence-based medicine.

“We all see that animals feel better, look better and have improved appetites when renal disease patients are given subcutaneous fluids, despite a lack of published research papers supporting this,” Scanlan says.

 “In addition, preliminary research isn’t necessarily the gold standard. In humans, only one COX-2 inhibitor remains on the market [Celebrex] because the side effects are so much worse than the benefits of those drugs taken off the market. I have personally seen sudden death from carprofen, meloxicam and deracoxib. I have never seen sudden death from acupuncture or herbs commonly used for arthritis, and I have been using them longer than the three Western drugs currently on the market.”
 
Scanlan says she and other CAVM-practicing veterinarians do not see the modalities as experimental, and she contends that thousands of years of use have provided enough evidence of effectiveness to continue the practice. 

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