Cushing's disease: a new approach to therapy in equine and canine patients.

Elliott, M., Br Homeopath J. 2001 Jan;90(1):33-6.

This paper is just over three pages long, but it manages to pack in a quota of howlers worthy of a much longer document.

It is very easy to spot the deficiencies in normal scientific terms.

However, even more startling is the list of irregularities from the homoeopathic point of view.  One feature of homoeopathic discourse is the propensity of homoepaths for dismissing negative studies carried out by non-homoeopaths on the grounds that proper homoeopathic procedures have not been followed.  It is therefore quite astounding to see that most of these objections could equally well be applied to this positive study carried out by a VetMFHom.

If this approach were to have any chance of becoming accepted, it would be essential to repeat the study in a properly scientific manner - that is, if ethical approval could be obtained for such an exercise, something which we wonder if Mr. Elliott even thought about.  Horses and dogs would have to be considered separately; definite confirmation of diagnosis would be required for every animal entering the study; animals would have to be split into treated and placebo-control groups and all participants blinded as to which was which; all animals would have to be followed up for a sufficiently long period; and assessment of clinical response would have to be strictly objective including the sort of laboratory studies which are mandatory when following up patients treated with the licensed treatment for this condition.

Supposing that were done, what do you think the outcome would be?  Yes, we know.  But the homoeopaths would have the answer for that.  "This study was not conducted according to proper homoeopathic principles!"  Allopathic diagnosis, absence of individualisation, isopathic selection of remedy and polypharmacy have all been invoked in the past to dismiss studies the homoeopaths didn't like.  (We're not sure about the dowsing, because it's not the sort of thing scientific researchers usually include in their protocols.)  Why, then are these acceptable (and all in the same study, no less!) just because a positive result is claimed?

Actually, that's precisely the point.  Homoeopaths seem to be able to do things exactly as they please, without criticism, so long as they are within the faith and they claim success.  However, as soon as success is not achieved, it is always possible to find some reason to explain away the lack of effect - as there is almost no consensus of agreement about how cases should be managed, there is plenty of scope for rationalising away lack of efficacy.  The one explanation which will never be countenanced is that whatever the outcome of the case, it would have happened anyway irrespective of the administration of the magic sugar pills.

Another consideration is that this exercise was quite clearly a clinical trial.  However, clinical trials have to be approved and licensed and authorised by ethics committees and things like that.  Vets can't just blithely decide to give experimental medicines to their patients in the interests of science, on their own initiative.  Any reputable journal would have confirmed that the requisite licences had been granted for any clinical trial they published.  However, it is completely impossible that any licence would have been granted for this study, because of its glaring scientific inadequacies.  It seems likely this trial was actually illegal.

It seems a real pity that Horizon chose to highlight this deeply flawed piece of work as evidence that homoeopathic remedies work in animals, without checking its credibility, or giving the slightest acknowledgement to the scientifically-conducted studies which have shown no effect.

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