Evidence and intuition in animal health and wellbeing

I feel very grateful and honored to have been joined to co-host the latest free Q&A call by the wonderful Kathy Price of Point of Balance. Our topic was “Evidence and intuition in animal health and wellbeing” and it really was a stimulating discussion. 

There can be some strong feelings and division between “camps” in allopathic and alternative or complementary fields of medicine, and when facing health or wellbeing problems in individual cases it can be hard to know how to make decisions. I don’t subscribe to a “camps” mindset, I find it limiting and unhelpful. I also feel a huge sense of responsibility towards my patients and their families to make good decisions for their wellbeing. How best to proceed?

Firstly, what is evidence-based veterinary medicine? Modern Western medicine strives to practice from a place of best evidence, which in most ways is a really excellent thing for patients, their family and clinicians. When practice is informed by well-designed, relevant, well-executed and well-analyzed studies, it should become more effective and safer.

But that is not to say that all studies contributing to the evidence base are well-designed, relevant, well-executed and well-analyzed. Mostly they should be, especially when in peer-reviewed journals, but there is a risk that the move towards solely evidence based practice means that if the studies in a particular topic are thin on the ground, using the only currently available evidence is what happens. This evidence might not actually be very high quality or applicable to certain individual situations.

It is also not to say that where evidence is either lacking or is poor quality, we are at a total loss. We humans have been practicing various types of medicine and surgery for thousands of years. There is no doubt that certain aspects used to be (and in some cases still are) harmful or incredibly risky, and that science has improved this hugely. But actually, we have helped other beings to get better as well. This has involved working from first principles, not solely robust scientific evidence in that exact case type, plus the use of skill and feel, and more than this - I can’t claim to know about energy work, but I can claim to have felt it. And it is true that on an individual level, we see and feel beneficial effects from many types of complementary and alternative medicine. What’s happening there?

I’m not sure I know the answer, but my thoughts on this include remaining truly open-minded in order to help every patient in the best way for them. The first thought framework I have for decision-making in this area is: Which modalities are safe and ethical in this situation? In answering this question we should take into account the urgency and severity of the health condition, the degree of truly robust and applicable evidence for its diagnosis and treatment, and how the patient is going to respond to those interventions, not just clinically, but also mentally and emotionally. It is most beneficial to treat patients as whole beings, not just their disease. 

Where does the placebo effect come into all of this? In human medicine, the placebo effect is so strong that we have to design studies that account for it. When patients respond to placebo, they do so physiologically, it isn’t imagined. The mind and body aren’t actually separate at all, that’s a construct in our modern Western thinking that doesn’t ring true. And I think we should be interested in why and how the placebo effect works, rather than it being seen as an irritating extra variable to deal with in studies. When it comes to the possibility of using it clinically though, we still have to ask the question - when is it safe and ethical to do so? This is not an easy one to answer but informed consent is definitely part of it.  

The placebo effect can’t really exist in animal patients, because they would need to conceptualize that taking a tablet or having an injection or an operation was supposed to make them better. Animals understand far more than we give them credit for, but I’m not sure they can grasp exactly that concept. We still have double-blinded trials in veterinary medicine, ostensibly to deal with human bias, but I can’t shake the feeling that there is a caring and even healing energy that goes alongside treating animals that is hugely beneficial to them and cannot be ignored.

We considered medicines and their intended effects and side effects. This led on to an explanation of the four deep roots to health and wellbeing that I have found most cases of dis-ease to fall into. In considering these deep roots, states of health and wellbeing will improve, either instead of, or alongside, other interventions like medications. These four deep roots are: husbandry for happiness (basically a species-appropriate lifestyle that honours all-round health and wellbeing); movement medicine (how movement affects and is affected by all body systems and cognitive and emotional states); cultivating comfort (preventing, alleviating or removing pain and discomfort on physical, mental and emotional levels); and communication, compassion and consent (how relationships based on these principles give choice and a voice and make for beings that feel a sense of safety, agency and vitality, and this goes for both the animal and the human in the relationship).

Now comes the discussion of what I think is a much-needed paradigm shift in thinking. Our society is results-oriented in general, and of course it is crucial for results to be critically examined when it comes to such things as medications, surgical interventions, radiotherapy and the like. It just wouldn’t be safe or ethical to use them otherwise. (I would also just say that in a lot of cases it would not be safe or ethical NOT to use them.) However, as an overall approach to improving health and wellbeing, I feel strongly that the process, not just the outcome, should be something to deeply consider.

There are no guarantees with anything, and nothing is zero risk. You can carry out the gold standard with outstanding ability and the utmost care and attention and still end up with an undesirable outcome. Worsening disease, additional problems, collateral damage, and death happen even when we are following absolutely best evidence.

Here’s the thing with this. If the process has been so rooted in staying true to core values such as deep care and compassion, authenticity and integrity, then it is a sacred and in fact still a healing process, regardless of the final outcome.

I believe one of the reasons modern medicine and healthcare don’t always honour the process in this way is unfortunately because our hyper-results-focusedness (if that is a term) is linked with blame culture and fear of litigation. It would always only be a minority who would cynically pursue litigation, and in most cases complaints have a very worthwhile basis and are beneficial for growth. But when systems become caught up with a fear of blame they become hyper-focused on results and the “only correct way” to be doing something, rather than with whether we all stayed true to ourselves during the process, but it was ultimately out of our hands.

This leads nicely on to the discussion about intuition. I can’t claim to understand this either, but personally in my clinical practice I can say that I get feelings in my body that help to guide me when I consider different options. I have no idea whether these are “correct” or not. So it is a question of balancing reasoned, analytical thinking and deeper knowings in fulfilling what I feel is a sacred responsibility to safeguard the animal’s health and wellbeing.

When it comes to making decisions, it’s a joint decision-making process with the owner, their family and the animal all involved. Having the animal involved is essential - watching their responses, having a process of two-way communication and considering their nature is a vital part of safeguarding the whole animal, not just treating their disease. My process that I call Attuned Assessment, where the animal is a participant in the process of evaluating them, helps to see more than a conventional physical examination can often achieve.

We talked about how our modern society doesn’t necessarily give us permission to listen to our gut feelings, and about cleansing ourselves from the often taxing demands of healing processes. And about how life isn’t easy or comfortable, but gloriously full of the whole spectrum of feeling.

If you would like to listen to the recording of this Q&A call you can do so via my monthly membership programme for only £3 / month - click on the Monthly Membership link to sign up.