Complementary and alternative therapies

The British Small Animal Veterinary Association (BSAVA) recognises that owners may seek alternative and complementary therapies for their animals for a wide range of reasons, however in the interests of animal welfare:

The BSAVA recommends that owners consider the evidence for a particular treatment and the qualifications and experience of the practitioner before embarking on any complementary or alternative therapy for their pet.

The BSAVA strongly recommends that treatment of animals is only undertaken after appropriate assessment and diagnosis by a veterinary surgeon.

The BSAVA strongly recommends that whenever possible treatment decisions are based on sound scientific evidence to support the safety and efficacy of the therapy.

The BSAVA strongly recommends that owners should seek advice from their veterinary surgeon before using any form of complementary or alternative therapy in their animals.

Legal situation

The diagnosis of diseases in and injuries to animals (including tests performed on animals for diagnostic purposes), as well as giving advice based upon such diagnosis, and the medical or surgical treatment of animals, are considered to be acts of “veterinary surgery” as defined by Section 19 of the Veterinary Surgeons Act 1966. Subject to a small number of exceptions diagnosis and treatment of animals may only be carried out by registered members of the Royal College of Veterinary Surgeons (RCVS).

The Animal Welfare Act 2006 imposes a duty on the owner of or other person in charge of an animal to ensure that its welfare needs are met. This includes the need to be protected from pain, suffering, injury and disease.

Veterinary Medicinal Products are defined as any substance or combination of substances presented as having properties for treating or preventing disease in animals; or any substance or combination of substances that may be used in, or administered to, animals with a view either to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or to making a medical diagnosis. In the UK these products are subject to control on the manufacture, authorisation, marketing, distribution and post-authorisation surveillance as detailed in the Veterinary Medicines Regulations.

RCVS Position

The Royal College of Veterinary Surgeons (RCVS) is the regulatory body for veterinary surgeons and veterinary nurses in the UK. It upholds and advances veterinary standards so as to enhance society through improved animal health and welfare.  In 2017 RCVS issued a position statement on Complementary and Alternative Medicines. The statement, which does not contradict BSAVA’s statement, supports the evidence-base and sound scientific foundation on which the Profession operates and reiterates it’s members commitment to animal health and welfare. Access to the RCVS statement can be found here.

What is meant by complementary and alternative medicine

Complementary and alternative therapies are a diverse group of practices and products not considered part of conventional (mainstream) medicine. Although ‘complementary and alternative’ is often used as a single category, it can be useful to make a distinction between the two different ways of using these treatments.

Complementary therapies are used together with conventional medicine while alternative therapies are used instead of conventional medicine, although they are sometimes used at the same time as, but not in deliberate concert with, conventional medicine. ‘Integrative medicine’ is a term used to refer to treatments that combine conventional medicine with those complementary therapies for which there is reasonable evidence of safety and effectiveness.

Safety and efficacy

Health claims for many complementary and alternative therapies are far in excess of the available scientific data, and sometimes in frank contradiction to scientific evidence.

In making decisions about the use of complementary and alternative therapies it is important to consider their safety and efficacy. Many people assume that all complementary and alternative therapies are natural and therefore safe, but this is not always the case. All therapies may produce unwanted side effects or may interact with other therapies. In the case of alternative therapies it is also important to consider the welfare implications of withholding conventional treatments.

There is a great deal of variation in both the degree to which various complementary and alternative therapies have been scientifically tested, and to which such testing has provided evidence supporting their efficacy. Establishing the efficacy of a therapy is not always straightforward; many conditions may fluctuate over time or resolve on their own.

Within any one branch of complementary medicine, e.g., herbal remedies or physiotherapy, there may be products or procedures with reasonable evidence of efficacy and safety for certain conditions, but others for which the evidence is poor or indicates that the product or procedure is ineffective.

Assessing the evidence

Some people, including owners, therapists and veterinary surgeons, may perceive that the therapies work as a result of belief in the therapy (placebo effect); anecdotal evidence (extrapolation from hearsay or personal experience of a single or small number of cases) or errors in inference (cognitive bias).

There are three factors strongly associated with whether or not any one medical treatment is likely to be efficacious:

1. A rational scientific basis

Modern medicine works, and it works because it is founded on a scientific base. Although not all treatments used in conventional medicine have a strong evidence base in the sense of rigorous clinical trials showing their efficacy they do have a rational scientific / pathophysiological basis for their use.

2. Degree of certainty

The effects of some treatments are so clear cut that further testing is not required. It has famously been pointed out that rigorous clinical trials are not needed to prove that parachutes reduce morbidity and mortality among people falling from aeroplanes. Similarly, one does not need rigorous trials to show that intravenous anaesthetics cause a rapid, profound loss of consciousness suitable for carrying out surgery. However, the effects of many treatments are much less certain; e.g., they are less closely associated in time with their effect, or the effect caused is much less dramatic, smaller and/or more variable in magnitude and/or time of onset. In such circumstances, given the variable time courses of many diseases, it can be remarkably difficult to determine whether a given treatment is actually efficacious or not.

3. Evidence

When there is anything less than absolute certainty about the efficacy of a treatment, then evidence is important in deciding whether a treatment is safe and efficacious. However, history has also shown that evidence – both in the form of clinical experience and individual clinical research results – can be misleading. The process of evidence-based (veterinary) medicine exists to improve our confidence by formally and systematically searching for all of the relevant evidence and formally and systematically grading the quality and reliability of that evidence.

Choosing a practitioner

Regulation exists to protect patient safety: it does not by itself mean that there is scientific evidence that a treatment is effective.

Currently, practitioners of two complementary and alternative therapies are regulated in the same way as practitioners of conventional medicine. They are osteopathy and chiropractic. This regulation is called statutory professional regulation.

If you want to use a complementary and alternative medicine where practitioners are not regulated by professional statutory regulation, you should make use of professional bodies or voluntary registers, where they exist, to help you find a practitioner.

You may want to check what arrangements there are for complaining about a practitioner. For example, does the association or register accept complaints, and what action will they take if you have concerns about your treatment?

Referral

• Further information about the Veterinary Surgeon’s Act and complementary therapy can be found on the RCVS website
• Animal Welfare Act
• Further information on the regulations relating to veterinary medicines can be found on the website of the Veterinary Medicines Directorate (VMD) 

Scientific Committee 2013
BSAVA Council November 2013
RCVS update November 2017