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Editor's Note: There are veterinary professionals who have welcomed alternative, holistic, and complementary therapies and modalities with open arms, adding these tools and treatments to their arsenal of care for equine patients. And there are professionals who take to task anyone who makes claims that they consider are unproven, unscientific, or inappropriate for horses. The horse owner often is put in the position of having to make a decision on what is best for his or her animal, and to determine if the person doing the treating is in fact qualified and trained. In the following articles, we offer varying views on the use of "natural" products and alternative therapies. While some "therapies" have more proponents and are used extensively in all levels of sport, others are potentially more dangerous. Some "natural" products you can buy don't contain any of the key ingredients they claim are effective, and none are licensed as medicines. Research is being conducted by top professionals on several of these therapies, but in the meantime we as horse owners should follow the veterinarian's oath and "First, do no harm."
Nature is the source of a number of healing remedies. Some plants have properties that can help alleviate certain signs of arthritis. Others have been touted as giving assist in healing burns and wounds. Still others are proported help a laminitic horse heal. Today, a number of veterinarians are incorporating what is known as the "holistic" approach to the practice of equine medicine.
It hasn't been all that long ago that many in the fields of human and equine medicine looked at these approaches as quackery (and some practitioners still do). However, as more veterinarians become educated in the uses of alternative or complementary medicine, the entire medical community is taking a fresh look at the holistic approach. For instance, there now is a Physicians Desk Reference For Herbal Medicines.
There are some strong arguments in favor of using the holistic approach, says Joyce Harman, DVM, MRCVS, of Washington, Va. Harman makes use of herbs, homeopathic remedies, chiropractic, and acupuncture in her practice that includes backyard horses as well as high-level sport and performance horses. Those arguments, she says, include the facts that natural products can be less invasive and have fewer side effects than some of the conventional medicinal products. At the same time, she said, no one natural product is a cure-all.
Unfortunately, there are, and perhaps always will be, individuals who claim their specific approach is a cure-all, be it a medicinal substance or a particular procedure.
"Snake oil salesmen still exist," Harman says. "Be wary when anyone suggests that they have a product or an approach that 'cures everything.' "
Generally speaking, natural products being used by horse owners today, Harman says, fall into three categories--herbs, homeopathic remedies, and nutritional supplements. While there are a number of advantages in utilizing these alternative forms of medicine, she says, there also can be dangers involved. Just because something is a natural product does not mean that it is always safe, she said.
"Medicine, whether using natural products or those that are more conventional, is powerful," she says. "What can heal, can also harm."
In this country, Harman says, the prevailing sentiment of horse owners often is, "If a little is good, a lot must be better." One of the major problems involving the use of natural remedies, she says, is overuse. When an animal's body is assaulted by too much of a good thing, it doesn't know how to respond. Sometimes its immune system is compromised as well.
To understand how practitioners utilize natural medicine, one first must try to learn a little about it.
Herbology
Take herbology, for example. It certainly isn't something that just reared its head in the medical community. In fact, herbal medicine was the only form of medicine that existed for many centuries. Quite simply, herbology involves the selective use of herbs to treat disease.
Examples of how herbs are used in animals is giving garlic to ward off insects, ginseng to enhance endurance, valerian to calm nervous animals, and aloe to soothe burns and sores. Many of these herbal products can be purchased in fresh form, dried, in oils or extracts, and in poultices and creams. Normally, says Harman, the herbs used in topical ointments pose little danger to the user or animal. The same is not always true for herbs that are ingested. More about that in a moment.
It is likely that prehistoric man first utilized various herbs and plants in medicinal healing. Perhaps early-day humans observed animals eating a particular plant or gnawing on the bark of a specific tree when ill. One can believe that the early humans might have mimicked these actions and discovered that certain plants or barks alleviated pain or discomfort. Through trial and error, one can assume, they found out which plants helped.
Compilations of plant-based remedies were found from early in human history. In 77 AD, a Greek pharmacologist named Pedanius Dioscorides compiled a list of about 1,000 plant-based remedies, although he was not the first to do so. The Chinese, Harman says, carefully documented the effects of a variety of herbs long before that. The Greek physician Hippocrates in the fifth century BC used powder extracted from the bark of willow trees to treat pain and reduce fever. More modern-day research (early 1800s) revealed that willow bark contained salicin. Today, a refinement of this is known as aspirin and is manufactured in synthetic form.
In the 17th Century, European explorers learned that the bark of the South American cinchona tree could be used to treat malaria. The trees were attacked with vigor as the remedy gained popularity, and soon there was a scarcity of cinchona bark.
There can be drawbacks and dangers involved in the use of herbs, especially by lay persons. Herbs, although found in nature, are not always free of contaminants and other properties that can be harmful, says Harman. Some plants, for example, contain toxic substances. So, yes, the plant might contain a substance that is beneficial, but it might also contain another substance, or substances, that could cause harm.
Harm also can come, says Harman, if remedies are inappropriately mixed. One remedy might negate the good that is achieved by another if both are administered at the same time. There also is the problem of giving "herbal" remedies along with prescription drugs without the attending veterinarian (or physician) knowing about the remedies given by an owner to a horse (or an individual to himself). The potential for problem medication interactions is quite real.
Proponents of herbal treatments stress that herbs are not a quick cure. Harman says positive results might take one to two months. If there is no improvement after that point, she says, it is time to change the remedy. However, she adds, this does not mean merely switching to another brand label. It might mean changing to an entirely different class of herbs. If you are having no, or poor, response, she says, don't just throw more formulas into the feed, hoping to find one that works. "You need to consult with a veterinarian knowledgeable in herbal medicine."
Homeopathy
Proponents say homeopathic remedies have a more rapid treatment result than herbs. If a homeopathic remedy is properly administered, Harman says, positive results can be observed in as little as one or two days for specific acute conditions, and one to three weeks for some chronic conditions, rather than the one or two months for those conditions treated with herbs.
"The concept," says Harman of homeopathy, "is that like heals like." The thought is that if a substance can cause a particular symptom in a healthy person, a dilution of that substance could be used to treat that symptom in a sick person.
A German physician named Samuel Hahnemann, who made use of the approach in the 1700s, is considered to be the modern-day founder of this form of medical treatment. Hahnemann spent a good deal of time in translating new and old medical texts into and out of his native German. It was during this work that he developed the basis of homeopathic law.
Hahnemann conducted a number of experiments to prove his theories, often using himself as the test subject. The first experiment, conducted on himself, involved quinine or cinchona. He wrote that taking quinine produced symptoms similar to malaria, which quinine is used to treat. In essence, his experiments involved at-tempting to cause the disease, then using the same substance in diluted form to treat the problem.
In 1796, Hahnemann published his findings, and homeopathy as we know it today was born.
A solid background in veterinary homeopathy and medicine is essential if this modality and others like it are to be successful, Harman declares.
Homeopathy carries with it some inherent problems. In order to utilize the approach to its maximum advantage, a complete medical history of the animal must be in the hands of the homeopath. This can be a problem to any practitioner in the horse world, where the horse might have passed from one owner to another, but without its medical history being passed along with it.
The sheer number of remedies available also can be frustrating, Harman says. It is estimated that there are about 2,000 homeopathic remedies available. Knowing specifically which one to use can be a challenge, to say the least.
One of the most difficult things to comprehend about homeopathy is the minute quantity of a given remedy that is involved. The homeopath starts with a solution of established chemical strength. Then, one part of the solution is added to 99 parts of a diluent, such as water. The dilution is shaken violently by a mechanical device. This new dilution is described as being 1C potency because it is a 1:100 dilution of the original solution. The C stands for centesimal.
That initial step, however, often is only the beginning. Next, one part of the 1C solution is further diluted by taking one part of it and adding 99 parts of diluent. Again the new dilution is shaken violently. The new solution is then labeled as 2C potency. It actual strength is 1:10,000 of the original solution.
In some remedies, the original substance might be diluted as many as 30 times or more until, in a manner of speaking, the original substance barely exists. Yet, homeopaths maintain, the remedy can have a positive effect.
Supplements
The term nutraceutical has been coined by combining the words nutritional and pharmaceutical. Nutraceutical supplements, says Harman, are purified ingredients that either can be natural or synthetic. The goal with supplements is to provide a correct balance of vitamins, minerals, and other essential substances within the body. Here, too, Harman says, the door is wide open for inappropriate use. A case in point, she says, is the use of supplements for joint problems. In a number of cases, horse owners are combining three or four items in the belief that if a little is good, a lot will be better. In reality, she says, the additional supplements generally are doing little or no good and are costing the horse owner a small fortune in the process.
There is even published evidence that some "nutraceuticals" don't contain any of the ingredient that is supposed to help.
"Fortunately, most of the supplements are safe," she says, "and, as a rule, little harm befalls the horse if it receives more than is needed. However, we really do not know the long-term effects of over-feeding these compounds. In humans, there is some evidence of bleeding disorders associated with long-term use of the joint products in some people."
When using homeopathic or natural products to treat acute problems, such as cuts, abrasions, bruises, puncture wounds, and infections, the approach is straight-forward, says Harman. Some of the chronic conditions that homeopaths treat are colic, diarrhea, skin disease, and respiratory problems. However, unless these types of chronic conditions are treated correctly, Harman says, the treatment actually can exacerbate the problem.
She used the herb echinacea as an example. It has been used with some success as both a treatment and preventative substance for the flu. However, Harman says, if too much is administered, the body's immune system becomes fatigued and doesn't function as it should.
Inappropriate use also can stem from not reading the labels on natural products, Harman says. She used yucca as a case in point. Yucca contains some anti-inflammatory properties and is thought to help alleviate pain and inflammation. In order to be effective, Harman says, it must be ingested at a certain level. The problem is, she adds, many of the products claiming to contain yucca have only a minute quantity--far less than would be considered a therapeutic level.
This is one of the major problems with nutraceuticals--there is no federal control over content or purity.
"At least half of the yucca preparations on the market don't contain a therapeutic level," she says. That isn't the only problem, she adds: Not all manufacturers are created equal. Some of them simply do a better job than others in preparation of natural products, she says.
Harman believes that two conditions from which horses suffer--arthritis and laminitis--are better treated with natural products than conventional methods. She says nutritional formulas, Western herbs, and Chinese herbs can elicit a beneficial response in the arthritic horse.
Laminitis
To this point, we have been discussing the use and abuse of natural products in more general terms. It is time to take a look at how a holistic veterinarian practitioner approaches a specific disease.
One of the most dreaded afflictions of horses is laminitis. Every horse owner knows the classic symptoms. The pain in the acute stage often is so extreme that, if the condition afflicts the front feet only, as is often the case, the horse will literally rock back on its rear legs to ease the pressure on extremely painful front feet.
Years of research have sought to determine exactly what causes laminitis, what specifically occurs within the foot when the affliction strikes, and the best way to treat it when it does occur. Many veterinarians use a conventional approach when dealing with laminitis. In a number of cases, this involves the administration of non-steroidal anti-inflammatory drugs (NSAIDs) to ease the pain and inflammation.
The practitioner who makes use of natural products as part of a holistic approach follows a different path.
Harman and Madalyn Ward, DVM, of Austin, Texas, recently co-authored a paper titled, "Laminitis Treatment From a Natural Medicine Perspective." The paper, in its entirety, was published in the Spring 2000 edition of Hoofcare and Lameness magazine, a lay publication. In the paper, Harman and Ward discussed holistic approaches for dealing with the specific problem of laminitis. They also discussed the natural products that can be used and what these products can accomplish in the healing process. By examining their holistic approach to treating laminitis, we can learn about how such a practitioner approaches a malady.
Excerpts from that paper, along with Harman's comments, will be included in our examination of putting natural products to use in treating a specific malady.
Before beginning, we must pay heed to Harman's admonition that just as should be done in Western medicine, each horse must be treated as an individual by a holistic practitioner, no matter what the animal's affliction, and that all of the steps that follow for laminitis might not be needed or recommended for each and every horse. She also emphasizes that when the holistic approach is taken, it should be by a veterinarian who is well educated in holistic medicine. Just because natural products are being used, she repeats, does not mean that they cannot do harm if improperly administered.
With those admonitions as background, let us take a look at how a holistic practitioner deals with a specific malady.
"The goal in holistic treatment of chronic laminitis," Harman and Ward wrote, "is to provide nutritional support to prevent and reverse damage from circulating free radicals, prevent further damage to and encourage healthy laminar attachments, and return the horse's metabolism to proper balance.
"The important thing to remember when you are treating laminitis with natural medicine is to approach each case individually. It can be detrimental to use the 'shotgun' approach with multiple supplements or treatment modalities. Because a product is natural does not rule out harmful effects or the negative effects of using too many products and overloading the body."
One of the conventional aspects of laminitis treatment with which the holistic practitioner takes issue is the administration of NSAIDs because of their adverse effect on the equine GI tract. In her experience, Harman says, the removal of NSAIDs from the treatment program is one of the most important aspects of the success of the holistic approach. Continued use of NSAIDs, she maintains, actually can exacerbate the problem because a horse with less pain might be exercising more than it should and causing damage to its feet in the process. When NSAIDs are removed in the treatment protocol, she says, the horse might experience more pain in the beginning.
"When horses feel better with natural medicine," she says, "it is because they are better, not because we have masked the pain."
(Some practitioners who don't condone the holistic approach will disagree with these statements, saying that not alleviating the pain is wrong, and that relieving pain is not the same as masking pain.)
Harman also emphasizes the need stabilize the intestinal areas with beneficial bacteria.
"Beneficial bacteria," Harman and Ward wrote, "are natural inhabitants of the horse's digestive system. They help to maintain proper pH levels in the system. They manufacture vitamins--such as biotin--digest fiber, and produce natural antibiotics. Healthy bacteria are also important for the absorption of minerals." (The pH levels in the gut affect the solubility of the minerals.)
Also highly important to the horse's system, says Harman, is glutamine, an amino acid that is a primary fuel for the enterocytes of the small intestine. Glutamine levels, she says, are affected by any decrease in feed intake as well as any stress placed on the intestines.
"Glutamine," wrote Harman and Ward, "should be used in any horse that is not eating correctly, as well as any horse where intestinal wall integrity may be questionable."
Once the digestive system is properly supported, if that is a need, Harman says, it is time to look at nutrient needs. Harman says the nutritional requirements for horses with laminitis are higher and more specific than for non-laminitic horses.
"Horses with laminitis need high-fiber, low-carbohydrate diets," she and Ward wrote. "The entire diet should be evaluated to keep it balanced. Blue-green algae can be added to the bran mash to prove amino acids and trace minerals and support hoof growth. Grass or other lower protein hays can be given free choice. The horse can have some alfalfa along with grass hay, especially if more protein is needed, but generally, alfalfa should not be the only hay received."
If the horse has signs of Cushing's syndrome with altered insulin levels or diabetes, they stated, the feed should be low in sugar.
"When evaluating the feeding program," Harman and Ward wrote, "be sure to look at the treats being given, as apples and carrots are high in sugar when given in quantity. Carrots may be desirable for some horses as a natural source of beta carotene. Sweet feeds should be avoided.
"Higher levels of protein, up to 14%, and calories may be needed in the horses with weight loss problems. Laminitic horses that are normal weight or underweight often do well on the senior diets, which are high fat. Many horses with chronic laminitis lose weight due to the stress of walking in pain and actually need increased amounts of feed.
"Since these horses often did not founder due to grain or carbohydrate overload, it makes no sense to restrict their calories when they need extra calories to heal themselves. Increased calories can be given as fats (vegetable oils or rice bran) and are well digested by most horses. Often, it is best to increase calories rather than use high-protein feeds and hays, although some horses do need the higher protein."
Again, the individuality of treatment is emphasized. What might be a proper diet for one horse might be totally inappropriate for another.
In laminitic horses, damage is caused by free radicals that are out of control, Harman and Ward stated. The way to reverse this overabundance of free radicals, they maintained, is by administering high levels of antioxidants at first, then using lower levels for maintenance. Listed below are some of the antioxidants that Harman and Ward use and their comments on each:
Coenzyme Q10
Valuable in reversing free radical damage, they said. Coenzyme Q10 "clinically seems to be one of the best antioxidants for use in the horse, and in laminitis cases, can be so effective that the horses rapidly become more comfortable."
Vitamin C
This is an excellent antioxidant and nutrient for collagen and the immune system.
MSM
This product is a natural source of the antioxidant mineral sulfur.
Other antioxidants
Vitamin E, superoxide dismutase (SOD), and dimethylglycine (DMG) are others available for use.
The laminitic horse often is in need of mineral supplementation, the authors say. It also is highly important that the laminitic horse receive an adequate supply of vitamins. Listed among food-source vitamin-mineral supplements are: blue-green algae, kelp, apple cider vinegar, carrots, and oranges.
Following is a portion of a concluding excerpt from the paper authored by Harman and Ward concerning the various holistic remedies that can be employed when treating the laminitic horse.
Homeopathy
Constitutional homeopathy needs to be prescribed based on the history, clinical signs, and personality of the horse. Quite a few of the remedies used to treat problems associated with vaccination are used successfully, lending support to the holistic theory that over-vaccination might be part of the problem.
Acute remedies are selected based on the clinical signs and might change during the acute phase of the problem. In most cases, standard acute remedies work well, but in some cases, it must be remembered that the acute signs are exacerbations of chronic disease.
Chinese Medicine
Chinese medicine, both acupuncture and herbs, can be used to help laminitic horses. It is best to work with a veterinarian experienced in either herbs or acupuncture. The International Veterinary Acupuncture Society has a list of qualified practitioners from around the world.
Western Herbs
Aloe vera is a nutritional herb that will support healthy bacterial growth and help heal the damaged intestinal lining.
Slippery elm bark
This is a nutritional herb that protects and aids in healing the intestinal wall. It is especially useful with aloe vera to heal the intestinal irritation secondary to the use of NSAIDs, such as phenylbutazone.
While Harman and Ward have discussed utilization of a number of natural products in a beneficial way for a specific malady, Harman again emphasizes that there can be misuse and/or abuse at each step unless the person in charge of the treatment is trained in veterinary medicine and the holistic approach.
As mentioned earlier, this in-depth look at the holistic way of treating laminitis allows us to learn how the holistic practitioner thinks and works when putting natural products to beneficial use. It involves treating the whole animal and doing it on a horse-by-horse basis.
Harman sums it up this way: "The joy and the frustration of holistic practice is that each animal is an individual and will respond differently. In treating these complex cases, it is important to proceed one step at a time."
The Appeal Of Alternatives
Editor’s note: Not all practitioners believe in alternative medicines; some feel that everything outside the realm of traditional “Western” medicine is wrong, and some believe in one method, but not another. In order to give a balanced view of the field of alternatives medicines, treatments, and uses, we invited a practitioner to give his side of the story. David Ramey, DVM, is one of the most outspoken critics of alternative therapies. An equine veterinarian in private practice in Glendale, Calif., he is the author of several books, including Horsefeathers: Facts versus Myths About Your Horse’s Health. In his latest book, Consumer’s Guide to Alternative Therapies in the Horse, he and colleagues reviewed the medical and veterinary literature concerning the major alternative therapies. Following is his view of alternative therapies.
The past two decades have given rise to a group of unrelated and diverse therapies that advocates have termed "alternative" or "complementary." It's curious that these unproven therapies have emerged at a time when scientific medical advances (including veterinary ones) also are occurring at an unprecedented rate. It's instructive to examine this group of therapies as a whole to see what they have in common.
The words used to describe this group of therapies, first proposed in the 1960s and 70s, are somewhat misleading and tend to obscure what's actually being proposed. One doesn't find "alternative" groups in fields such as airplane engineering or bridge building; violating the principles in such fields is a sure-fire recipe for disaster. Effective medicine either works or it doesn't, and there's no legitimate alternative to it.
Terms such as "alternative" and "complementary" are soothing and emotionally evocative. They tend to cast unproven and highly unlikely therapeutic claims in the most positive light possible. In fact, such therapies can't really be considered as genuine "alternatives," at least if you think of an "alternative" as one that is proven to be equal or superior to a scientific biomedical therapy in accomplishing a specific therapeutic end. Nor can they be considered genuinely "complementary" if they aren't shown to offer increased effectiveness, safety, reduced signs of disease, or decreased mortality when added to a proven treatment regimen.
So far, these treatments have not been shown to be a true "alternative" or a "complement" to anything.
The medical conditions common to the horse haven't really changed over time; however, approaches to treatment have changed, often dramatically, as new medical discoveries are made. One thing many "alternative" therapies have in common is that they are largely old therapies that have been pulled out of the dustbin of medical history and dressed up for popular consumption by modern advocates.
Acupuncture has been around for roughly two thousand years (at least in people--arguably for a much shorter period of time in horses); herbs have been proposed as medications for millennia; homeopathy is a couple of hundred years old. Historical veterinary books contain herbal recipes and homeopathic approaches to a number of easily recognized conditions of the horse. These approaches to equine diseases have a long history and they have long since been discarded because they did not prove effective. (One might reasonably assume that if a reliable cure for laminitis had been discovered in antiquity, everyone would still be using it.)
While the alleged successes of "Traditional Chinese Medicine" are widely celebrated, more sobering messages are often overlooked. For example, the July 3, 1998, San Jose Mercury News, for instance, bore a Washington Post article about public health in rural China, where Traditional Chinese Medicine would be expected to be most available. In spite of the availability of such therapy, various forms of parasitism afflict 70% of the population there, resulting in malnutrition, decreased intelligence, and general weakening of the workforce.
Another feature many "alternative" therapies have in common is that their practitioners and proponents assert that they are somehow "natural." As such, "natural" is used as a synonym for "good" and implies comfort, and soothing care. It should be rather obvious that this is not necessarily the case--such "natural" substances as poison hemlock or locoweed can hardly be considered benign. Nor would anyone consider the ingredients used to prepare some common homeopathic preparations--crushed honeybees, dog's milk, or duck liver, to name a few--to be anything immediately recognized as desirable, even if they do occur in nature.
A desire for "unity with nature" cuts across many cultures. In Germany, it's naturphilosophie. In Asia, it manifests as a reverence for tradition and a synthesis of spirituality and cosmology with all phases of life. Many North Americans are enamored of "naturopathy," "holistic" medicine, and folk traditions. People are drawn to what's comfortable, and they tend to resist giving up folk beliefs and traditional healing methods. They repeat quaint and familiar ideas and superstitions. Colic is caused by changes in the weather (it isn't). Cold water on hot muscles causes cramps and muscle damage (it doesn't). On the other hand, technical, professional, and scientific medicine is only about a hundred years old. It keeps changing--the volume of medical information is estimated to double every four years. It's not easily understood. Still, the dramatic changes in quality of life and advances in the cure and care of disease have come almost exclusively from the revolutions brought about by modern medicine.
As a group, "alternative" and "complementary" therapies tend to find a niche in one of three areas. The first is where no cure currently exists. Where there is a cure, such as giving intravenous fluids in the treatment of dehydration, there is no "alternative." However, conditions such as laminitis and arthritis have no known cure. As such, the use of any therapeutic modality that currently is available might not be successful, opening the door for any number of treatment possibilities.
Second, alternative therapies abound for the treatment of things that are likely to be OK anyway. Things such as minor scrapes or sprains can most likely be successfully treated by any number of approaches--these conditions tend to get better on their own unless the therapy gets in the way. So whether you use homeopathic arnica, an herbal poultice, or a dose of pain reliever, your horse's sole bruise is most likely going to get better on its own if you give it some time. Curiously, when treatments coincide with self-limiting conditions, the treatment provided usually gets the credit for therapeutic "success."
Third, "alternatives" find a place in the treatment of horses which have no signs of disease, or in horses where no demonstrable medical problem can be reliably diagnosed. It's easy to be persuaded that a regular dose of herbs is "good for your horse's metabolism" or that "adjustments" help keep your horse's spine in good working order. Acupuncture purports to treat back pain, although a reliable way to diagnosis back pain in the horse has yet to be determined. Under such circumstances, it's difficult to show that such therapies have any benefit at all or, conversely, it's easy to imagine that there's been some benefit when none has been provided. Indeed, concern about "wellness care," or attributing vague problems to and/or providing treatments for poorly defined conditions, opens the door for virtually unlimited opportunities for any number of devices and treatments to get incorporated into your horse's care (and your pocketbook).
One quick test for the usefulness of an "alternative" therapy is to ask yourself what would happen if tomorrow it were no longer available? How much would acupuncture or homeopathy or chiropractic be missed? If you had never heard of them, would your horse's health suffer? Could you say the same for antibiotics, colic surgery, or a tetanus vaccination? Another test is to turn the question around. If acupuncture is effective because it's been around for so long, why are there still questions about its usefulness?
The real danger comes when "alternative" treatments are proposed for conditions that can be cured. Under such circumstances, you might be playing with fire. Your horse's leg wound might respond equally well to an herbal dressing or to bandaging with an antibiotic dressing. However, if the serious leg wound is infected and the herbal dressing isn't effective, an infection might result and your horse might suffer, be permanently disfigured, or even die. Nor is adding a "complementary" therapy to one that is already effective necessarily a good thing. Indeed, adding as many therapies as possible for the treatment of a single condition is mostly a good way to drive up the cost of care.
There always has been a fringe of "healers" willing to supply methods rejected by scientific biomedicine. As a result of vigorous promotion and uncritical acceptance, a minority of the public now has firm belief in the power of supplements, antioxidants, magnets, and in the idea that medicine is somehow harmful. In most cases, such beliefs cause little harm, but the potential for harm is there. Products with debatable or no effects have always been made and sold, sometimes competing with effective products. There has always been good grazing at the edges of the pastures of medicine.
Nature is the source of a number of healing remedies. Some plants have properties that can help alleviate certain signs of arthritis. Others have been touted as giving assist in healing burns and wounds. Still others are proported help a laminitic horse heal. Today, a number of veterinarians are incorporating what is known as the "holistic" approach to the practice of equine medicine.
It hasn't been all that long ago that many in the fields of human and equine medicine looked at these approaches as quackery (and some practitioners still do). However, as more veterinarians become educated in the uses of alternative or complementary medicine, the entire medical community is taking a fresh look at the holistic approach. For instance, there now is a Physicians Desk Reference For Herbal Medicines.
There are some strong arguments in favor of using the holistic approach, says Joyce Harman, DVM, MRCVS, of Washington, Va. Harman makes use of herbs, homeopathic remedies, chiropractic, and acupuncture in her practice that includes backyard horses as well as high-level sport and performance horses. Those arguments, she says, include the facts that natural products can be less invasive and have fewer side effects than some of the conventional medicinal products. At the same time, she said, no one natural product is a cure-all.
Unfortunately, there are, and perhaps always will be, individuals who claim their specific approach is a cure-all, be it a medicinal substance or a particular procedure.
"Snake oil salesmen still exist," Harman says. "Be wary when anyone suggests that they have a product or an approach that 'cures everything.' "
Generally speaking, natural products being used by horse owners today, Harman says, fall into three categories--herbs, homeopathic remedies, and nutritional supplements. While there are a number of advantages in utilizing these alternative forms of medicine, she says, there also can be dangers involved. Just because something is a natural product does not mean that it is always safe, she said.
"Medicine, whether using natural products or those that are more conventional, is powerful," she says. "What can heal, can also harm."
In this country, Harman says, the prevailing sentiment of horse owners often is, "If a little is good, a lot must be better." One of the major problems involving the use of natural remedies, she says, is overuse. When an animal's body is assaulted by too much of a good thing, it doesn't know how to respond. Sometimes its immune system is compromised as well.
To understand how practitioners utilize natural medicine, one first must try to learn a little about it.
Herbology
Take herbology, for example. It certainly isn't something that just reared its head in the medical community. In fact, herbal medicine was the only form of medicine that existed for many centuries. Quite simply, herbology involves the selective use of herbs to treat disease.
Examples of how herbs are used in animals is giving garlic to ward off insects, ginseng to enhance endurance, valerian to calm nervous animals, and aloe to soothe burns and sores. Many of these herbal products can be purchased in fresh form, dried, in oils or extracts, and in poultices and creams. Normally, says Harman, the herbs used in topical ointments pose little danger to the user or animal. The same is not always true for herbs that are ingested. More about that in a moment.
It is likely that prehistoric man first utilized various herbs and plants in medicinal healing. Perhaps early-day humans observed animals eating a particular plant or gnawing on the bark of a specific tree when ill. One can believe that the early humans might have mimicked these actions and discovered that certain plants or barks alleviated pain or discomfort. Through trial and error, one can assume, they found out which plants helped.
Compilations of plant-based remedies were found from early in human history. In 77 AD, a Greek pharmacologist named Pedanius Dioscorides compiled a list of about 1,000 plant-based remedies, although he was not the first to do so. The Chinese, Harman says, carefully documented the effects of a variety of herbs long before that. The Greek physician Hippocrates in the fifth century BC used powder extracted from the bark of willow trees to treat pain and reduce fever. More modern-day research (early 1800s) revealed that willow bark contained salicin. Today, a refinement of this is known as aspirin and is manufactured in synthetic form.
In the 17th Century, European explorers learned that the bark of the South American cinchona tree could be used to treat malaria. The trees were attacked with vigor as the remedy gained popularity, and soon there was a scarcity of cinchona bark.
There can be drawbacks and dangers involved in the use of herbs, especially by lay persons. Herbs, although found in nature, are not always free of contaminants and other properties that can be harmful, says Harman. Some plants, for example, contain toxic substances. So, yes, the plant might contain a substance that is beneficial, but it might also contain another substance, or substances, that could cause harm.
Harm also can come, says Harman, if remedies are inappropriately mixed. One remedy might negate the good that is achieved by another if both are administered at the same time. There also is the problem of giving "herbal" remedies along with prescription drugs without the attending veterinarian (or physician) knowing about the remedies given by an owner to a horse (or an individual to himself). The potential for problem medication interactions is quite real.
Proponents of herbal treatments stress that herbs are not a quick cure. Harman says positive results might take one to two months. If there is no improvement after that point, she says, it is time to change the remedy. However, she adds, this does not mean merely switching to another brand label. It might mean changing to an entirely different class of herbs. If you are having no, or poor, response, she says, don't just throw more formulas into the feed, hoping to find one that works. "You need to consult with a veterinarian knowledgeable in herbal medicine."
Homeopathy
Proponents say homeopathic remedies have a more rapid treatment result than herbs. If a homeopathic remedy is properly administered, Harman says, positive results can be observed in as little as one or two days for specific acute conditions, and one to three weeks for some chronic conditions, rather than the one or two months for those conditions treated with herbs.
"The concept," says Harman of homeopathy, "is that like heals like." The thought is that if a substance can cause a particular symptom in a healthy person, a dilution of that substance could be used to treat that symptom in a sick person.
A German physician named Samuel Hahnemann, who made use of the approach in the 1700s, is considered to be the modern-day founder of this form of medical treatment. Hahnemann spent a good deal of time in translating new and old medical texts into and out of his native German. It was during this work that he developed the basis of homeopathic law.
Hahnemann conducted a number of experiments to prove his theories, often using himself as the test subject. The first experiment, conducted on himself, involved quinine or cinchona. He wrote that taking quinine produced symptoms similar to malaria, which quinine is used to treat. In essence, his experiments involved at-tempting to cause the disease, then using the same substance in diluted form to treat the problem.
In 1796, Hahnemann published his findings, and homeopathy as we know it today was born.
A solid background in veterinary homeopathy and medicine is essential if this modality and others like it are to be successful, Harman declares.
Homeopathy carries with it some inherent problems. In order to utilize the approach to its maximum advantage, a complete medical history of the animal must be in the hands of the homeopath. This can be a problem to any practitioner in the horse world, where the horse might have passed from one owner to another, but without its medical history being passed along with it.
The sheer number of remedies available also can be frustrating, Harman says. It is estimated that there are about 2,000 homeopathic remedies available. Knowing specifically which one to use can be a challenge, to say the least.
One of the most difficult things to comprehend about homeopathy is the minute quantity of a given remedy that is involved. The homeopath starts with a solution of established chemical strength. Then, one part of the solution is added to 99 parts of a diluent, such as water. The dilution is shaken violently by a mechanical device. This new dilution is described as being 1C potency because it is a 1:100 dilution of the original solution. The C stands for centesimal.
That initial step, however, often is only the beginning. Next, one part of the 1C solution is further diluted by taking one part of it and adding 99 parts of diluent. Again the new dilution is shaken violently. The new solution is then labeled as 2C potency. It actual strength is 1:10,000 of the original solution.
In some remedies, the original substance might be diluted as many as 30 times or more until, in a manner of speaking, the original substance barely exists. Yet, homeopaths maintain, the remedy can have a positive effect.
Supplements
The term nutraceutical has been coined by combining the words nutritional and pharmaceutical. Nutraceutical supplements, says Harman, are purified ingredients that either can be natural or synthetic. The goal with supplements is to provide a correct balance of vitamins, minerals, and other essential substances within the body. Here, too, Harman says, the door is wide open for inappropriate use. A case in point, she says, is the use of supplements for joint problems. In a number of cases, horse owners are combining three or four items in the belief that if a little is good, a lot will be better. In reality, she says, the additional supplements generally are doing little or no good and are costing the horse owner a small fortune in the process.
There is even published evidence that some "nutraceuticals" don't contain any of the ingredient that is supposed to help.
"Fortunately, most of the supplements are safe," she says, "and, as a rule, little harm befalls the horse if it receives more than is needed. However, we really do not know the long-term effects of over-feeding these compounds. In humans, there is some evidence of bleeding disorders associated with long-term use of the joint products in some people."
When using homeopathic or natural products to treat acute problems, such as cuts, abrasions, bruises, puncture wounds, and infections, the approach is straight-forward, says Harman. Some of the chronic conditions that homeopaths treat are colic, diarrhea, skin disease, and respiratory problems. However, unless these types of chronic conditions are treated correctly, Harman says, the treatment actually can exacerbate the problem.
She used the herb echinacea as an example. It has been used with some success as both a treatment and preventative substance for the flu. However, Harman says, if too much is administered, the body's immune system becomes fatigued and doesn't function as it should.
Inappropriate use also can stem from not reading the labels on natural products, Harman says. She used yucca as a case in point. Yucca contains some anti-inflammatory properties and is thought to help alleviate pain and inflammation. In order to be effective, Harman says, it must be ingested at a certain level. The problem is, she adds, many of the products claiming to contain yucca have only a minute quantity--far less than would be considered a therapeutic level.
This is one of the major problems with nutraceuticals--there is no federal control over content or purity.
"At least half of the yucca preparations on the market don't contain a therapeutic level," she says. That isn't the only problem, she adds: Not all manufacturers are created equal. Some of them simply do a better job than others in preparation of natural products, she says.
Harman believes that two conditions from which horses suffer--arthritis and laminitis--are better treated with natural products than conventional methods. She says nutritional formulas, Western herbs, and Chinese herbs can elicit a beneficial response in the arthritic horse.
Laminitis
To this point, we have been discussing the use and abuse of natural products in more general terms. It is time to take a look at how a holistic veterinarian practitioner approaches a specific disease.
One of the most dreaded afflictions of horses is laminitis. Every horse owner knows the classic symptoms. The pain in the acute stage often is so extreme that, if the condition afflicts the front feet only, as is often the case, the horse will literally rock back on its rear legs to ease the pressure on extremely painful front feet.
Years of research have sought to determine exactly what causes laminitis, what specifically occurs within the foot when the affliction strikes, and the best way to treat it when it does occur. Many veterinarians use a conventional approach when dealing with laminitis. In a number of cases, this involves the administration of non-steroidal anti-inflammatory drugs (NSAIDs) to ease the pain and inflammation.
The practitioner who makes use of natural products as part of a holistic approach follows a different path.
Harman and Madalyn Ward, DVM, of Austin, Texas, recently co-authored a paper titled, "Laminitis Treatment From a Natural Medicine Perspective." The paper, in its entirety, was published in the Spring 2000 edition of Hoofcare and Lameness magazine, a lay publication. In the paper, Harman and Ward discussed holistic approaches for dealing with the specific problem of laminitis. They also discussed the natural products that can be used and what these products can accomplish in the healing process. By examining their holistic approach to treating laminitis, we can learn about how such a practitioner approaches a malady.
Excerpts from that paper, along with Harman's comments, will be included in our examination of putting natural products to use in treating a specific malady.
Before beginning, we must pay heed to Harman's admonition that just as should be done in Western medicine, each horse must be treated as an individual by a holistic practitioner, no matter what the animal's affliction, and that all of the steps that follow for laminitis might not be needed or recommended for each and every horse. She also emphasizes that when the holistic approach is taken, it should be by a veterinarian who is well educated in holistic medicine. Just because natural products are being used, she repeats, does not mean that they cannot do harm if improperly administered.
With those admonitions as background, let us take a look at how a holistic practitioner deals with a specific malady.
"The goal in holistic treatment of chronic laminitis," Harman and Ward wrote, "is to provide nutritional support to prevent and reverse damage from circulating free radicals, prevent further damage to and encourage healthy laminar attachments, and return the horse's metabolism to proper balance.
"The important thing to remember when you are treating laminitis with natural medicine is to approach each case individually. It can be detrimental to use the 'shotgun' approach with multiple supplements or treatment modalities. Because a product is natural does not rule out harmful effects or the negative effects of using too many products and overloading the body."
One of the conventional aspects of laminitis treatment with which the holistic practitioner takes issue is the administration of NSAIDs because of their adverse effect on the equine GI tract. In her experience, Harman says, the removal of NSAIDs from the treatment program is one of the most important aspects of the success of the holistic approach. Continued use of NSAIDs, she maintains, actually can exacerbate the problem because a horse with less pain might be exercising more than it should and causing damage to its feet in the process. When NSAIDs are removed in the treatment protocol, she says, the horse might experience more pain in the beginning.
"When horses feel better with natural medicine," she says, "it is because they are better, not because we have masked the pain."
(Some practitioners who don't condone the holistic approach will disagree with these statements, saying that not alleviating the pain is wrong, and that relieving pain is not the same as masking pain.)
Harman also emphasizes the need stabilize the intestinal areas with beneficial bacteria.
"Beneficial bacteria," Harman and Ward wrote, "are natural inhabitants of the horse's digestive system. They help to maintain proper pH levels in the system. They manufacture vitamins--such as biotin--digest fiber, and produce natural antibiotics. Healthy bacteria are also important for the absorption of minerals." (The pH levels in the gut affect the solubility of the minerals.)
Also highly important to the horse's system, says Harman, is glutamine, an amino acid that is a primary fuel for the enterocytes of the small intestine. Glutamine levels, she says, are affected by any decrease in feed intake as well as any stress placed on the intestines.
"Glutamine," wrote Harman and Ward, "should be used in any horse that is not eating correctly, as well as any horse where intestinal wall integrity may be questionable."
Once the digestive system is properly supported, if that is a need, Harman says, it is time to look at nutrient needs. Harman says the nutritional requirements for horses with laminitis are higher and more specific than for non-laminitic horses.
"Horses with laminitis need high-fiber, low-carbohydrate diets," she and Ward wrote. "The entire diet should be evaluated to keep it balanced. Blue-green algae can be added to the bran mash to prove amino acids and trace minerals and support hoof growth. Grass or other lower protein hays can be given free choice. The horse can have some alfalfa along with grass hay, especially if more protein is needed, but generally, alfalfa should not be the only hay received."
If the horse has signs of Cushing's syndrome with altered insulin levels or diabetes, they stated, the feed should be low in sugar.
"When evaluating the feeding program," Harman and Ward wrote, "be sure to look at the treats being given, as apples and carrots are high in sugar when given in quantity. Carrots may be desirable for some horses as a natural source of beta carotene. Sweet feeds should be avoided.
"Higher levels of protein, up to 14%, and calories may be needed in the horses with weight loss problems. Laminitic horses that are normal weight or underweight often do well on the senior diets, which are high fat. Many horses with chronic laminitis lose weight due to the stress of walking in pain and actually need increased amounts of feed.
"Since these horses often did not founder due to grain or carbohydrate overload, it makes no sense to restrict their calories when they need extra calories to heal themselves. Increased calories can be given as fats (vegetable oils or rice bran) and are well digested by most horses. Often, it is best to increase calories rather than use high-protein feeds and hays, although some horses do need the higher protein."
Again, the individuality of treatment is emphasized. What might be a proper diet for one horse might be totally inappropriate for another.
In laminitic horses, damage is caused by free radicals that are out of control, Harman and Ward stated. The way to reverse this overabundance of free radicals, they maintained, is by administering high levels of antioxidants at first, then using lower levels for maintenance. Listed below are some of the antioxidants that Harman and Ward use and their comments on each:
Coenzyme Q10
Valuable in reversing free radical damage, they said. Coenzyme Q10 "clinically seems to be one of the best antioxidants for use in the horse, and in laminitis cases, can be so effective that the horses rapidly become more comfortable."
Vitamin C
This is an excellent antioxidant and nutrient for collagen and the immune system.
MSM
This product is a natural source of the antioxidant mineral sulfur.
Other antioxidants
Vitamin E, superoxide dismutase (SOD), and dimethylglycine (DMG) are others available for use.
The laminitic horse often is in need of mineral supplementation, the authors say. It also is highly important that the laminitic horse receive an adequate supply of vitamins. Listed among food-source vitamin-mineral supplements are: blue-green algae, kelp, apple cider vinegar, carrots, and oranges.
Following is a portion of a concluding excerpt from the paper authored by Harman and Ward concerning the various holistic remedies that can be employed when treating the laminitic horse.
Homeopathy
Constitutional homeopathy needs to be prescribed based on the history, clinical signs, and personality of the horse. Quite a few of the remedies used to treat problems associated with vaccination are used successfully, lending support to the holistic theory that over-vaccination might be part of the problem.
Acute remedies are selected based on the clinical signs and might change during the acute phase of the problem. In most cases, standard acute remedies work well, but in some cases, it must be remembered that the acute signs are exacerbations of chronic disease.
Chinese Medicine
Chinese medicine, both acupuncture and herbs, can be used to help laminitic horses. It is best to work with a veterinarian experienced in either herbs or acupuncture. The International Veterinary Acupuncture Society has a list of qualified practitioners from around the world.
Western Herbs
Aloe vera is a nutritional herb that will support healthy bacterial growth and help heal the damaged intestinal lining.
Slippery elm bark
This is a nutritional herb that protects and aids in healing the intestinal wall. It is especially useful with aloe vera to heal the intestinal irritation secondary to the use of NSAIDs, such as phenylbutazone.
While Harman and Ward have discussed utilization of a number of natural products in a beneficial way for a specific malady, Harman again emphasizes that there can be misuse and/or abuse at each step unless the person in charge of the treatment is trained in veterinary medicine and the holistic approach.
As mentioned earlier, this in-depth look at the holistic way of treating laminitis allows us to learn how the holistic practitioner thinks and works when putting natural products to beneficial use. It involves treating the whole animal and doing it on a horse-by-horse basis.
Harman sums it up this way: "The joy and the frustration of holistic practice is that each animal is an individual and will respond differently. In treating these complex cases, it is important to proceed one step at a time."
The Appeal Of Alternatives
Editor’s note: Not all practitioners believe in alternative medicines; some feel that everything outside the realm of traditional “Western” medicine is wrong, and some believe in one method, but not another. In order to give a balanced view of the field of alternatives medicines, treatments, and uses, we invited a practitioner to give his side of the story. David Ramey, DVM, is one of the most outspoken critics of alternative therapies. An equine veterinarian in private practice in Glendale, Calif., he is the author of several books, including Horsefeathers: Facts versus Myths About Your Horse’s Health. In his latest book, Consumer’s Guide to Alternative Therapies in the Horse, he and colleagues reviewed the medical and veterinary literature concerning the major alternative therapies. Following is his view of alternative therapies.
The past two decades have given rise to a group of unrelated and diverse therapies that advocates have termed "alternative" or "complementary." It's curious that these unproven therapies have emerged at a time when scientific medical advances (including veterinary ones) also are occurring at an unprecedented rate. It's instructive to examine this group of therapies as a whole to see what they have in common.
The words used to describe this group of therapies, first proposed in the 1960s and 70s, are somewhat misleading and tend to obscure what's actually being proposed. One doesn't find "alternative" groups in fields such as airplane engineering or bridge building; violating the principles in such fields is a sure-fire recipe for disaster. Effective medicine either works or it doesn't, and there's no legitimate alternative to it.
Terms such as "alternative" and "complementary" are soothing and emotionally evocative. They tend to cast unproven and highly unlikely therapeutic claims in the most positive light possible. In fact, such therapies can't really be considered as genuine "alternatives," at least if you think of an "alternative" as one that is proven to be equal or superior to a scientific biomedical therapy in accomplishing a specific therapeutic end. Nor can they be considered genuinely "complementary" if they aren't shown to offer increased effectiveness, safety, reduced signs of disease, or decreased mortality when added to a proven treatment regimen.
So far, these treatments have not been shown to be a true "alternative" or a "complement" to anything.
The medical conditions common to the horse haven't really changed over time; however, approaches to treatment have changed, often dramatically, as new medical discoveries are made. One thing many "alternative" therapies have in common is that they are largely old therapies that have been pulled out of the dustbin of medical history and dressed up for popular consumption by modern advocates.
Acupuncture has been around for roughly two thousand years (at least in people--arguably for a much shorter period of time in horses); herbs have been proposed as medications for millennia; homeopathy is a couple of hundred years old. Historical veterinary books contain herbal recipes and homeopathic approaches to a number of easily recognized conditions of the horse. These approaches to equine diseases have a long history and they have long since been discarded because they did not prove effective. (One might reasonably assume that if a reliable cure for laminitis had been discovered in antiquity, everyone would still be using it.)
While the alleged successes of "Traditional Chinese Medicine" are widely celebrated, more sobering messages are often overlooked. For example, the July 3, 1998, San Jose Mercury News, for instance, bore a Washington Post article about public health in rural China, where Traditional Chinese Medicine would be expected to be most available. In spite of the availability of such therapy, various forms of parasitism afflict 70% of the population there, resulting in malnutrition, decreased intelligence, and general weakening of the workforce.
Another feature many "alternative" therapies have in common is that their practitioners and proponents assert that they are somehow "natural." As such, "natural" is used as a synonym for "good" and implies comfort, and soothing care. It should be rather obvious that this is not necessarily the case--such "natural" substances as poison hemlock or locoweed can hardly be considered benign. Nor would anyone consider the ingredients used to prepare some common homeopathic preparations--crushed honeybees, dog's milk, or duck liver, to name a few--to be anything immediately recognized as desirable, even if they do occur in nature.
A desire for "unity with nature" cuts across many cultures. In Germany, it's naturphilosophie. In Asia, it manifests as a reverence for tradition and a synthesis of spirituality and cosmology with all phases of life. Many North Americans are enamored of "naturopathy," "holistic" medicine, and folk traditions. People are drawn to what's comfortable, and they tend to resist giving up folk beliefs and traditional healing methods. They repeat quaint and familiar ideas and superstitions. Colic is caused by changes in the weather (it isn't). Cold water on hot muscles causes cramps and muscle damage (it doesn't). On the other hand, technical, professional, and scientific medicine is only about a hundred years old. It keeps changing--the volume of medical information is estimated to double every four years. It's not easily understood. Still, the dramatic changes in quality of life and advances in the cure and care of disease have come almost exclusively from the revolutions brought about by modern medicine.
As a group, "alternative" and "complementary" therapies tend to find a niche in one of three areas. The first is where no cure currently exists. Where there is a cure, such as giving intravenous fluids in the treatment of dehydration, there is no "alternative." However, conditions such as laminitis and arthritis have no known cure. As such, the use of any therapeutic modality that currently is available might not be successful, opening the door for any number of treatment possibilities.
Second, alternative therapies abound for the treatment of things that are likely to be OK anyway. Things such as minor scrapes or sprains can most likely be successfully treated by any number of approaches--these conditions tend to get better on their own unless the therapy gets in the way. So whether you use homeopathic arnica, an herbal poultice, or a dose of pain reliever, your horse's sole bruise is most likely going to get better on its own if you give it some time. Curiously, when treatments coincide with self-limiting conditions, the treatment provided usually gets the credit for therapeutic "success."
Third, "alternatives" find a place in the treatment of horses which have no signs of disease, or in horses where no demonstrable medical problem can be reliably diagnosed. It's easy to be persuaded that a regular dose of herbs is "good for your horse's metabolism" or that "adjustments" help keep your horse's spine in good working order. Acupuncture purports to treat back pain, although a reliable way to diagnosis back pain in the horse has yet to be determined. Under such circumstances, it's difficult to show that such therapies have any benefit at all or, conversely, it's easy to imagine that there's been some benefit when none has been provided. Indeed, concern about "wellness care," or attributing vague problems to and/or providing treatments for poorly defined conditions, opens the door for virtually unlimited opportunities for any number of devices and treatments to get incorporated into your horse's care (and your pocketbook).
One quick test for the usefulness of an "alternative" therapy is to ask yourself what would happen if tomorrow it were no longer available? How much would acupuncture or homeopathy or chiropractic be missed? If you had never heard of them, would your horse's health suffer? Could you say the same for antibiotics, colic surgery, or a tetanus vaccination? Another test is to turn the question around. If acupuncture is effective because it's been around for so long, why are there still questions about its usefulness?
The real danger comes when "alternative" treatments are proposed for conditions that can be cured. Under such circumstances, you might be playing with fire. Your horse's leg wound might respond equally well to an herbal dressing or to bandaging with an antibiotic dressing. However, if the serious leg wound is infected and the herbal dressing isn't effective, an infection might result and your horse might suffer, be permanently disfigured, or even die. Nor is adding a "complementary" therapy to one that is already effective necessarily a good thing. Indeed, adding as many therapies as possible for the treatment of a single condition is mostly a good way to drive up the cost of care.
There always has been a fringe of "healers" willing to supply methods rejected by scientific biomedicine. As a result of vigorous promotion and uncritical acceptance, a minority of the public now has firm belief in the power of supplements, antioxidants, magnets, and in the idea that medicine is somehow harmful. In most cases, such beliefs cause little harm, but the potential for harm is there. Products with debatable or no effects have always been made and sold, sometimes competing with effective products. There has always been good grazing at the edges of the pastures of medicine.