Jeffrey Bryan, DVM, MS, PhD, DACVIM (Oncology)
Dr. Jeffrey Bryan is the NextGen Precision Health Cancer Faculty Research Lead at the University of Missouri (MU) and an associate director of comparative oncology at the Ellis Fischel Cancer Center at MU Health Care. His research focuses on comparative examination of cancers in companion animals to better understand cancers in all species. A recent example: Dr. Bryan led a study of an herbal derivative that targets iron in tumors.
During my first private practice job, my boss asked me to get certified in acupuncture. So I took the first of four International Veterinary Acupuncture Society (IVAS) courses—and then considered quitting my job. Here I was, a UC Davis-trained veterinarian, and I couldn't believe I was engaging in this quackery.
But certification was non-negotiable from my boss's perspective. So, I took the second IVAS course, which taught practical points about treating arthritis. I'd been treating a dog with severe end-stage arthritis for a long time and had tried everything, so I decided to try acupuncture. I needled the dog, thinking it couldn't hurt.
About 45 minutes after the client and dog left, the receptionist told me the client was on the phone crying. I figured I'd killed her dog with acupuncture. I picked up the phone, bracing myself, when she told me Sissy had just jumped on the couch for the first time in three years. I was hooked on acupuncture after that and got certified in 1995.
Truly complementary applications
In the next few years I saw more and more patients whose owners were looking for alternative cancer treatment options. When explaining the benefits of chemotherapy for lymphoma, for example, I'd tell clients that acupuncture could reduce side effects. These experiences ultimately inspired me to become an oncologist.
I certainly don't believe acupuncture is a panacea, but neither is it meant to be. For one thing, we Westerners tend to turn it on its head. In Chinese medicine, if you're having an imbalance in your health, you first deal with environment and diet. Then you turn to herbs. The third more invasive level is to see an acupuncturist. In the U.S., we head to McDonald's on the way to the acupuncturist. Still, we see the power of acupuncture in many instances even though we somewhat disrespect the cultural origin in our applications.
The Web That Has No Weaver: Understanding Chinese Medicine by Ted Kaptchuk, OMD. This book describes the philosophy of Chinese medicine from a pathogenic principle standpoint, along with the Five Elements Theory. It makes these concepts understandable in a practical way.
The more I learned about the Chinese medicine approach to health and disease, the less I needed it to balance with my Western understandings of pathophysiology. I'd decide how to treat patients based on my veterinary training in allopathic medicine, then combine that with nontraditional therapies to help the animal regain a better quality of life.
"The more I learned about the Chinese medicine approach to health and disease, the less I needed it to balance with my Western understandings of pathophysiology."
There are some truly complementary ways Western and Eastern medicine fit together. The National Institutes of Health website notes acupuncture as effective for issues like lower back pain, osteoarthritis and nausea—I used it primarily for the latter. In the Chinese medical model, acupuncture can support bone marrow function and potentially alleviate the low blood counts associated with chemotherapy. Some published evidence supports this, but it's not the highest level.
Evidence exists, but not our evidence
I acknowledge that the highest level of Western clinical research is not always brought to bear on acupuncture, but there are some reasons for this. To complete a controlled trial and give Chinese medicine its due, the treatment group would need to receive acupuncture applied according to Chinese medicine principles. That means customizing needles to the patient rather than using a one-size-fits-all approach. But this doesn't follow the scientific method model, which involves doing something the exact same way with many patients and comparing the results. The other question is what to do for a control group. There are a few options, like using sham needling or no needles. But the reality is, acupuncture doesn't lend itself well to a treatment and control group in every case.
"Saying acupuncture hasn't been tested is a bit chauvinistic, because there is research. It's just not written in English and conducted the way we'd typically conduct it."
At the same time, there's a tremendous amount of literature applying science to acupuncture that's written in Chinese languages and published in Chinese medical journals, but not easily accessible to Western reading. Saying acupuncture hasn't been tested is a bit chauvinistic, because there is research. It's just not written in English and conducted the way we'd typically conduct it.
Clinical Acupuncture: Scientific Basis by Gabriel Stux and Richard Hammerschlag includes descriptions of studies that provide physical evidence to support the concept of chi. For example, in one study of rabbits using functional MRI, researchers looked at stimulation of stomach 36 versus spleen 6. These areas of the body appear to share reasonably similar innervation, yet they light up completely different parts of the cerebral cortex in the rabbit on the functional MRI.
Education: Resistance is futile–and ignorant
I'm not sure we're doing enough to educate future veterinarians on integrative medicine. That said, there's so much to learn in veterinary school that trying to teach other forms of medicine is nearly impossible. At the very least, we need to prepare veterinarians to communicate comfortably and intelligently with clients.
Evidence shows that many people are already using nutraceuticals and other supplements with their pets. If pet owners know you're biased against supplement therapy, they'll give their animals whatever they want and won't tell you. That can lead to drug interactions and is to the detriment of the patient. If a client tells says they're giving an herb and we respond that we don't think homeopathy works, then we sound ignorant, because the client knows homeopathy and herbal medicine are not the same thing.
"Integrative Veterinary Medical Education and Consensus Guidelines for an Integrative Veterinary Medicine Curriculum within Veterinary Colleges," published in the Open Veterinary Journal in 2016. I was a co-author on this paper with lead author Dr. Mushtaq Memon from Washington State University. It provides an outline of a model integrative veterinary medicine course.
In my own clinical teaching, I try to make students aware of integrative medicine and help them find educational resources other than manufacturers' websites. Students also hear me tell clients that if a product claims to cure more than two things, I am skeptical. Lots of herbal supplements claim to cure cancer and stop arthritis and also clarify your mind. If it seems to fix everything, it probably doesn't.
In integrative and complementary medicine, we don't do ourselves any favors by overselling our approaches. Sometimes we may even give patients false hope. In fact, there are larger studies in human oncology that show people who seek first-line integrative or alternative care for cancer have shorter lifespans on average than people who go through the standard cancer treatments first.
Patient-focused, connective medicine
Acupuncture, Eastern medicine and the one chiropractic module I took changed how I approach the physical exam. They made me a much better physical diagnostician, because they made me more observant.
What I find truly phenomenal about Eastern medicine is that practitioners wouldn't think of treating a patient without evaluating multiple various subtleties in the body. They look at your tongue, feel your pulse, and ask numerous questions about how you hurt, when you hurt and what makes your pain worse or better. If you look at standard allopathic human medicine, it's basically the opposite.
Most of our own visits with human physicians are brief. Doctors don't dig too deep because that makes the appointment go on too long. Patients recognize they lack a direct connection intellectually, emotionally and physically. Being able to say, "It hurts here," and have someone put their hands on it makes a big difference.
The presence of a caretaker who listens, touches and is present is very bonding. One thing I learned from acupuncture is that you can be busy and still be present. If you are very present, you often don't need to be present for as long. If you clear your head, you can have a deep conversation and elicit what the client wants to share in only five or 10 minutes.
I appreciate the focus of Chinese medicine and integrative medicine on the patient. I'd say it's refreshing, but it's really our roots. There are elements of these forms of medicine we'd do well to adopt in our own medical approach. After all, being present, connected and focused on the individual patient allow us to provide better veterinary care–and that's what we're here to do.