The medicine seemed to work. That's the problem.

RE: The medicine seemed to work. That's the problem.

David Mills — Fri, 06 Mar 2026 01:55:05 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248453#248453"]

I don't think that's right (sorry).

AFAIK, 20-30% of people referred to epilepsy clinics turn out to have been misdiagnosed - but that's a very specific population, and of those, only a subset have cardiovascular cause, and a subset of that arrythmias.

https://pubmed.ncbi.nlm.nih.gov/10898432/

https://www.sciencedirect.com/science/article/abs/pii/S152550500900081X

https://pubmed.ncbi.nlm.nih.gov/17598602/

[/quote]

Interesting - thank you - aware you'll be far better informed than me about this.

It's bloody interesting though that epilepsy and syncope in humans is dificult to distinguish - 20-40% of those with suspected epilepsy don't have it. And this is humans.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5330016/#:~:text=Isolated%20syncope%20was%20diagnosed%20in,may%20contaminate%20%E2%80%9Cepilepsy%E2%80%9D%20cohorts.

We vets often rely on owner descriptions.

One top tip - opisthotonus in animals is almost always syncopal not seizure.

RE: The medicine seemed to work. That's the problem.

Alasdair Hotston Moore — Thu, 05 Mar 2026 09:05:06 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248428#248428"]

I think Glastonbury would give you a run for your money, Clare Tapsfield-Wright!

[/quote]

For sure. Easier to buy a wand than a loaf of sliced white

RE: The medicine seemed to work. That's the problem.

Lucy Fleming — Wed, 04 Mar 2026 13:34:35 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248428#248428"]I think Glastonbury would give you a run for your money, Clare Tapsfield-Wright![/quote]

Can confirm.

I think a lot of the folk truly wedded to the "all natural" route don't come and see us at all. Too allopathic, I suppose.

We do see a fair number of accidental non-pharmaceutical drug intoxications though.

RE: The medicine seemed to work. That's the problem.

Arlo Guthrie — Tue, 03 Mar 2026 09:59:13 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248429#248429"]Fun fact - a third of people on AEDs actually have an intermittent arrhythmia causing their signs. [/quote]

I don't think that's right (sorry).

https://pubmed.ncbi.nlm.nih.gov/10898432/

https://www.sciencedirect.com/science/article/abs/pii/S152550500900081X

https://pubmed.ncbi.nlm.nih.gov/17598602/

[quote userid="2490" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248449#248449"]i am shocked by how many children with learning difficulties and autism are medicated especially in the states and in South Africa.[/quote]

Clare Tapsfield-Wright - I wasn't aware of that, but I am not surprised to hear it. Over the years of treating my daughter I encountered a number of doctors who were seemingly ideologically wedded to the idea that medication was necessary, full stop (ie regardless of benefit). More who were determined to believe medication had worked: "So Arlo, less seizures this week, it's obviously working, isn't it.")

When I think how many millions of people around the world believe in homeopathy (it's huge in France, for example), it really doesn't feel like a big stretch to imagine over-medication happening on a grand scale because of the same cognitive errors that cause us to believe water is a cure for anything other than thirst.

RE: The medicine seemed to work. That's the problem.

Clare Tapsfield-Wright — Mon, 02 Mar 2026 18:46:08 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248428#248428"]On the quack end of the scale, I do not think human beliefs should be indulged. I hear the appeasement argument a lot (be nice, don't be critical and leave the door open from them to come back). [/quote]

Just to be clear I do not appease in the face of false beliefs and always have clearly stated that there is no evidence for homeopathy and I am all for evidence based medicine. I will always put the animal first but as you say these beliefs can sometimes only be challenged by changing minds by genuine positive response to tried and tested medicines.
Like you I have constantly had a battery of suggestions for supposed cures and treatments for my autistic son.
i am shocked by how many children with learning difficulties and autism are medicated especially in the states and in South Africa. Private medicine ? which is another topic

RE: The medicine seemed to work. That's the problem.

Beats — Sun, 01 Mar 2026 22:58:52 GMT

You don't have to fight back purely with the power of science - harness the power of anecdote yourself (if you wish) for maximal effect.

"Should I give my cat with HCM rapamycin?"

"There's no convincing evidence it will do any good, so probably at least as likely to be harmful as beneficial based on what we know. Did you hear that Bryan Johnston the Tech Billionaire has stopped taking it after discovering it had actually sped up his aging process instead of slowing it down?"

"What about turmeric for my dog's joints?"

"Should be harmless enough I would think - I've only ever seen one dog harmed by turmeric, and it must have sniffed too hard to get it up its nose, and the sneezing resolved pretty much by the next day. If a dog's just eating a little turmeric mixed well into its food I'd consider that to be totally harmless."

RE: The medicine seemed to work. That's the problem.

David Mills — Sun, 01 Mar 2026 20:08:17 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248428#248428"]"I always say, if you want to know what regression to the mean is, ask someone who has experience of epilepsy".[/quote]

Fun fact - a third of people on AEDs actually have an intermittent arrhythmia causing their signs. Nothing to do with seizures.

More widely, I just don't realy engage and say look whatever you're doing is unlikely to cause any harm (but it may do) but they won't be doing any good. As long as you come back here for ongoing care that's fine, give you dog/cat/rabbit what you want.

I disagree that just bcause we don't have strong evidence for a lot of drugs it opens the door to 'alternatives'. It's a question of relativivity. We do have some evidence, some quite strong (e.g. pimobendan, cardiac stuff). Alternatives have NO evidence that we would recognise as such. That's a huge difference.

RE: The medicine seemed to work. That's the problem.

Arlo Guthrie — Sun, 01 Mar 2026 19:35:05 GMT

[quote userid="2490" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248427#248427"]I live in Hebden Bridge and this is the town where all the hippies came and settled in the seventies [/quote]

I think Glastonbury would give you a run for your money, Clare Tapsfield-Wright!

[quote userid="2490" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248427#248427"]My approach was always to be clear that I was going to prioritise the pet and its welfare in my advice but I always tried to be supportive . I would emphasise the need to re examine to ensure the voodoo chanting was working and leave the door open for them to return and accept some conventional treatment .[/quote]

I think the first thing I would say is that we're not just talking about quackery here. That's just the more extreme end of it. People have all sorts of beliefs ranging from the plausible to the downright nuts, and the downright nuts are mostly outliers anyway.

My broader point is more about the strength with which people will believe and say something is working when in reality it isn't - whether that is a reiki crystal or a perfectly bona-fide prescription medicine.

On the quack end of the scale, I do not think human beliefs should be indulged. I hear the appeasement argument a lot (be nice, don't be critical and leave the door open from them to come back).

I think it is perfectly possible to be polite but firm that there is no evidence to support quackery, and that your job is to recommend things that have been tested. That wont stop someone coming back and importantly it doesn't indulge or tacitly endorse the idea that it is OK for them to use it.

But equally, at the other end of the scale, both patients and medical professionals can be utterly convinced something is working when in reality it is not, and at the very least the consequence of that may be unnecessary expense.

I know my experience is extreme. But it comes back to the point Michael Woodhouse made earlier about dogs on epilepsy medication.

As a neuro said to me the other day, "I always say, if you want to know what regression to the mean is, ask someone who has experience of epilepsy".

I am certain that if I had not been as aware of regression to the mean and false cause fallacy and confirmation bias, my daughter would still be on a cocktail of drugs that would have massively compromised her quality of life.

That surely is also true of dogs unnecessarily on long term seizure medication.

Now epilepsy might be an extreme one, but it's the same with everything really. Flea treatments. I gave the spot-on and my dog didnt get fleas. The treatment worked.

Er. No.

I wonder how many human and vetmed drugs are prescribed each year completely unnecessarily because of the errors in human thinking that cause us to believe it's working.

RE: The medicine seemed to work. That's the problem.

Clare Tapsfield-Wright — Sat, 28 Feb 2026 17:48:35 GMT

I live in Hebden Bridge and this is the town where all the hippies came and settled in the seventies so alternative medicine has always been popular here . If it isn’t homeopathy , crystal healing and checking your chakras then it’s clients trying to make their cats be vegan.
My approach was always to be clear that I was going to prioritise the pet and its welfare in my advice but I always tried to be supportive . I would emphasise the need to re examine to ensure the voodoo chanting was working and leave the door open for them to return and accept some conventional treatment . Frequently they did just that.
These clients were willing to pay a homeopath a lot of money and I think they felt they had value for money because the homeopathic consult was forty five minutes long . They were listened to at length and had their belief systems reinforced. Sometimes their animals did recover , especially those with skin conditions because the homeopathic consult would tell them to stop using lavender oil or some astringent shampoo or cream . Lo and behold they got better

RE: The medicine seemed to work. That's the problem.

Andreas Ege — Fri, 27 Feb 2026 18:57:06 GMT

[quote userid="2100" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem"]I've often found doctors to be in the grip of false cause fallacy and confirmation bias. I wonder whether the species of patient makes vets less prone to it. [/quote]

I don't think we're less prone to that. Largely, because that's how the human brain is wired to work, and the best we can achieve is being aware of the fact and working hard to minimalise these effects. But it's not likely we'll ever be able to fully prevent them.

I find it actually shocking, how often vets propagate evidence based medicine when actually they do cherry picking. While I was only locuming I often had the situation that I was criticized being in favour of raw feeding (and no, I don't think it's a panacea nor that it is suitable for every pet or owner or comes without risks) because theirs no good evidence for benefits but a fair amount about risks, with the same vet using ranitidine for every GI upset. When I pointed out that there's actually evidence ranitidine does not work in dogs and it's not indicated for a simple gastroenteritis, the usual answer was something along 'I know, but it seems to help'.

Recently I asked a specialist if they have any experience about a medical treatment, I got told no, they don't and they wouldn't use it, because there's no published peer reviewed evidence. Fair enough, but on the other hand they advocate a treatment as essential where there's no published peer reviewed (veterinary) evidence either.

I'm see clients with 'funny' ideas relatively regularly, I usually manage to get along with them relatively well even though I make it crystal clear that I don't think much of e.g. homeopathy and usually can get them aboard doing 'proper' medicine (if we actually have anything) at least along with the homeopathy or whatever. I think taking them seriously and not ridiculing their opinions or looking down on them goes a long way establishing a good relation and at least keep the animal partially covered by (hopefully) working diagnostics and treatments.

RE: The medicine seemed to work. That's the problem.

Arlo Guthrie — Fri, 27 Feb 2026 17:52:51 GMT

RE: The medicine seemed to work. That's the problem.

Dinu Catilina — Fri, 27 Feb 2026 15:00:00 GMT

Michael Woodhouse would you marry me?

RE: The medicine seemed to work. That's the problem.

Anthony Dennison — Fri, 27 Feb 2026 12:59:27 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248417#248417"]RCVS specialist orthopaedic surgeon who wants to screw or hammer something[/quote]

In a professional or personal capacity? Because with the reputation of orthopaedic surgeons, could be both.

Allegedly.

RE: The medicine seemed to work. That's the problem.

Arlo Guthrie — Fri, 27 Feb 2026 07:18:05 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248417#248417"] I'm unconvinced it will bring a patient out of true status[/quote]

I was going to say that I’m convinced it won’t, except the point of the film is precisely not to draw conclusions from my own observations, so the best I can say is that in my daughter’s case, it appeared to reduce seizure activity for the length of time it worked, but not to ‘break the cycle’. I’m also not surprised to read your comment about taking dogs off long term epilepsy medication. Avoiding unnecessary medication has been central to our approach, and I think it has served our daughter well.

[quote userid="3169" url="~/f/non-clinical-questions/31316/the-medicine-seemed-to-work-that-s-the-problem/248417#248417"]Then, and I have to be careful here, I worry about the vets, and sometimes how much of an expert in the matters of animal health they truly are.[/quote]

This very same point was made to me by another vet before I published the film, to which I made two points in reply.

First, vets may not be perfect either … either at critically assessing evidence, or at recognising cognitive errors and factoring them in (doctors aren't either), but by virtue of studying a scientific subject, you are better than most.

Second, my hope was that the film might be thought provoking for vets too, and maybe make a few think … I’m not as good as this film suggests, and perhaps I should be.

… Which is I think perhaps more productive than if I were to stand up and lecture.

RE: The medicine seemed to work. That's the problem.

Michael Woodhouse — Thu, 26 Feb 2026 23:52:08 GMT

In the words of Vicky Pollard - Well yea but no but yea but no but.

So little of what we do has good quality evidence behind it. That is a huge issue and one that isn't talked about anywhere nearly enough. Remembering that for ethical reasons, many drugs are simply tested against the usual treatment and frequently there is no true control group. The rectal diazepam is a good example - I'm unconvinced it will bring a patient out of true status - having used it a few times early in my career when presented with a fitting dog alone in the middle of the night. I don't prescribe it for owners to admin, but many vets do, including some of my colleagues..... Then we have some things where we have good safety evidence and colleagues fixate on smatterings of negative reports - Librea springs to mind, one of the greatest drugs to come out ever and suddenly half the profession is running scared from an amazing drug. You could even say causing unnecessary suffering by withholding an effective treatment....

Due to the lack of evidence, we have to fall back to our own experiences and the dirty tier "expert opinion". I think this is one area with much confusion, especially over the definition of the "expert". I am probably more of an expert at treating a dog with a pelvic fracture where funds are severely limited, than a RCVS specialist orthopaedic surgeon who wants to screw or hammer something. One of the many ways I've nearly been banned from VV, was expressing an opinion that if the options for a cat with a femoral fracture are amputation or PTS then a simple pin, or cage rest and analgesia are appropriate options to try first (because a pin works, even against the principles of orthopaedic surgery and I doubt there are specialists just placing a pin in that cat), and 99% of these fractures in cats will heal to good degree of functionality with rest and analgesia. The specialists don't see that, the mixed vets and charity practices may do - we are the experts in this case.

Then, and I have to be careful here, I worry about the vets, and sometimes how much of an expert in the matters of animal health they truly are. I wonder how right Tom Lonsdale is when I see some of the vet nutrition questions on VV, so many of these vets seem to have fallen for the hype that their own animal needs some fancy food to function, or believe in such tripe as "breed specific nutrition". It's sold as "science" but generally isn't. I wonder how many millions in turnover from CVS/IVC/V4P etc is selling unproven supplements - we can't really mock the owners' belief in homeopathy or crystals as we send them home with a magic tube of paste to fix the diarrhoea at £30 without a study/paper showing it actually does anything etc. I've seen referral reports where 1st opinion vets have missed a simple parasite. So many vets push for pre-anaesthetic bloods when the evidence doesn't support their use. Vets still culturing ears - really? They've bought a CT scanner, so plain films are no good any more. They can't look up a toxic dose of a substance and a treatment without speaking to a poisons expert. So much specialist and lab time taken up by vets ringing up to ask basic questions that should be general knowledge to a practitioner. I was speaking to a vet who worked for a drug company and took the phone for OOH emergencies related to their products - he said 95% of the calls they receive could be answered by reading the data sheet - lazy. With the internet, AI etc it's easier than ever to look things up, yet seemingly easier to ask a colleague or Facebook. As a new grad I was a NOAH compendium ninja, thought nothing of looking up a surgical procedure in a textbook the night before an operation, doing research in textbooks, now a complete unwillingness to look things up at night, attend evening CPD, work on VetGDP at home....... It's not a vocation any more and that is a monumental shame.

The older I get, the less bothered by people believing in alternative, unproven treatment I find myself. We give veterinary advice - the very definition is we say what we think they should do, but with any advice you receive you can take it or leave it. Doctors know smoking causes cancer, give people advice not to smoke or advise patients to quit, but then look at how many doctors smoke. When you accept they can take or leave your advice it makes you feel better when they do ignore it - some vets seem to think that because they gave advice it should be blindly followed! Happy to explain what works and what doesn't. Frequently take animals off unproven supplements. Happy people using them alongside conventional medicine, but would sack if their beliefs in something like homeopathy was causing harm - it's happened once in 20 years. Then I've taken a number of animals off lifelong medication they came to the practice on, and nothing bad has happened yet (a handful of dogs put on lifelong epilepsy medication after a single seizure when young). The human medics and evidence is starting to wake up and accept that gabapentin/pregabalin are actually not very good painkillers, and they have been miss prescribed - something else I try my best to get dogs off, and almost never prescribe.