I have been at the VA for several years and have enjoyed your columns. I was somewhat intrigued by the juxtaposition of two items in the November issue. The first, was the article (p.18) about two bills concerning service dogs in the VA. I am a huge dog lover and proponent of the overall benefits of having a dog, so this really stuck in my mind. The other was your editorial concerning alternative medicine. The direct quote from your [Dr. Buckenmaier] editorial was “… growing evidence of their effectiveness from rigorously designed and conducted clinical trials.” I whole-heartedly agree that moving forward and advancing therapies that are new, novel and previously considered unconventional, is essential to addressing many of the difficulties currently confronting our veterans (the quote from Einstein at the end of the article).
The article regarding dogs, however, shows the other side of this. The benefits of service dogs in the treatment of PTSD is currently under such study. Providing service dogs(HR2327) for PTSD patient without documenting the benefits of service dogs over support dogs would be an irresponsible use of resources, especially since there is apparently a study underway to address just this issue. The second bill (HR2225) is quite interesting in its design, but it will require a huge number of outcomes to be monitored as there will be outcomes for the veterans participating in the training as well as those receiving the animals. The article also highlights the additional danger here as it refers to two situations in which the dogs bit children. I believe this is more likely a problem with the execution as opposed to the concept, but it does add to the risk of a novel unproven treatment.
I generally find your comments both enlightening and enlightened. Your piece highlights the progression of novel therapies to the mainstream with strong evidence. The other piece shows the temptation to forge ahead without establishing the clinical evidence first.
Stuart Lipnick, MD, FACS
VISN 12 Chief Surgical Consultant
Jesse Brown VA Medical Center
University of Illinois at Chicago
Associate Program Director, Surgical Residency
Medical Student Site Coordinator