What Do You Do When There Are No Proven Treatments?

Apr 20, 2011 - 6:22 PM
If there is a proven cure for your horse's ailment, then everyone will use it. If there isn't, that's when things get interesting. Photo by © Laurent Saillard/Fotolia.com.

When you work providing care and treatment to horses, it doesn’t take long to realize that there’s only so much that you can do.

Medical conditions fall into one of three categories:

  • Things for which something can be done
  • Things for which there’s nothing that can be done
  • Things that get better on their own

An example of the first might be a laceration—it can be sewn up. An example of the second might be advanced arthritis of the horse’s knee—can’t be cured. An example of the third might be viral respiratory disease—which, like the common cold, will go away in fairly short order.

Of course, there’s also the interesting phenomena of problems that don’t really exist and their treatment, as well as the sincere efforts that people make to try to prevent problems that may not occur in the future, but those are other discussions.

It’s interesting how these concepts break down into what’s done to horses. When there is a condition for which something can clearly be done, everyone is doing it. So, for example, it a horse has a surgical colic, colic surgery is required. If the horse doesn’t get surgery, and it has a surgical colic, the horse will die. If the horse gets his surgery in a timely fashion, there’s a chance (no guarantees, of course) that things will be OK.

When horses are going to get better on their own, the sky is pretty much the limit. As long as something isn’t done that directly harms the horse, the horse will eventually get better, even in spite of its “treatment.”

So, for example, if you horse has viral respiratory disease, if he’s going to get better (and most do), then he will get better regardless of whether you give him antibiotics, herbs, vitamins or ancient Mayan incantations. If the problem is going to take care of itself, when it comes to treatments, the sky is pretty much the limit, because they are all going to look pretty good.

When horses aren’t going to get better—when there’s no cure—things get pretty interesting. In cases where there’s no cure, and most honest people will admit that there’s no cure, then the best that can be hoped for is to do the best that you can to help the horse deal with his problem. And, trust me; there are TONS of people that are willing to help. Be it concerned horse owners sharing a barn aisle, magazines, websites, chat rooms or any number of other experts, just about everyone has an opinion when it comes to helping your horse cope with its incurable problem.

The question then becomes, “How do you choose?” I mean, if everyone has a good idea for how to help your horse deal with its chronic laminitis, arthritis, navicular disease, or other similar long-term problems, and everyone’s opinion is different (sometimes opposite), unless you have some way to try to sort through the information, you’re going to end up going crazy!

Obviously, if there’s a proven therapy, even for an incurable condition, then pretty much everybody is going to use it. So, for example, in a horse with arthritis, injections of various substances into the affected joint(s) may help temporarily relieve pain and stiffness. But what if there is no proven treatment, or what if the proven treatments aren’t satisfactory? What do you do then?

In my opinion, faced with the lack of a proven treatment, it’s good to answer a few questions before proceeding. If you can follow these guidelines, even if the treatment doesn’t work, at least you’ll have made a rational decision.

1. If anyone tells you their treatment for an incurable condition is actually a cure, run. Effective treatments spread like wildfire, and everyone uses them. There’s no reason to avoid an effective treatment.

2. Make sure you can afford it. There’s no reason to bet the house on an unproven cure.

3. Ask for scientific information about the treatment. If the only information supporting the treatment comes from testimonials or glitzy advertisements, be skeptical.

4. Ask if follow-up data is available. If someone is promoting an unproven treatment, ask for information about follow-up on other, similar cases. Ask to talk to other people that have used the same treatment. Also ask if data is being gathered, so that other people can benefit. You really don’t want to pay for your horse to be an experiment for an unproven treatment where no one is keeping track.

5. Look for outside sources of information about the treatment. The Internet is a tremendous source of information, but it’s also a tremendous source of information. Look for conflicting data—if there’s information in support of a treatment but also information out there suggesting that it doesn’t work, the information that it doesn’t work is more likely to be true.

6. Don’t just rely on “experts,” unless they have good supporting data. Expert opinions carry the weight of authority, but when it comes to incurable conditions, the fact is that the experts—when they are really experts (which is another discussion)—are sometimes described as, “A person who is never in doubt but often in error.”

People love experts, and expect a lot from them. They are also very forgiving of them when treatments don’t work, and the experts may not follow up. It’s been that way for a long time. In 1757, Hsü Ta-ch’un, a Chinese intellectual, physician-scholar, and medical writer wrote on the impossibility of being a famous physician. He said, “The patients who do not understand the principles [of medicine] assume if someone has such a great name, he must be powerful enough to cause heaven to turn backwards…. The patients say ‘if this man treated [my illness] and it was not cured, it must be fate.’ ” Expert opinions, without supporting data, shouldn’t be taken at face value.

If your horse has a condition that can’t be cured, and you want to try an unproven treatment, it’s not irrational to want to do so. Nothing is more frustrating than standing around and doing nothing for your horse, particularly when you care about him so much. Sometimes, however, good medicine means more than simply trying treatment after treatment. And as much as you want to do something, remember, sometimes the old saying also works in reverse: “Don’t just do something—stand there!”

David W. Ramey, DVM, began veterinary practice in 1984 in the Los Angeles area of southern California, and he is still there today. His clinical practice specializes in the care and treatment of sport and pleasure horses. Dr. Ramey is a vocal advocate for the application of science to medicine, and, as such, for the welfare of the horse. He is an internationally known author and lecturer, and he’s written more than a dozen books on a variety of horse care topics. He’s also presented topics at the American Association of Equine Practitioners meeting seven times, most recently in 2008. To learn more about Dr. Ramey, visit http://www.doctorramey.com/.

The opinions expressed by www.chronofhorse.com columnists are entirely their own and not necessarily those of The Chronicle of the Horse. Always consult with your own veterinarian before undertaking any course of treatment for your animal or changing treatments or medications your veterinarian has already prescribed.

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