You probably throw away your (free) copy of Veterinary Times after reading it. This entire saga is therefore reproduced here for your edification. If anyone believes this is unfairly violating their copyright, I will remove the text from the page. It all began with a short, unsigned news article on the front page, on a cold and rainy day in February 2003 (no, I don't really remember the weather, I just made that bit up).
[Volume 33, no. 6, 24th February 2003, page 1.]
Complaint to RCVS a year after acquittal
THE RSPCA is reported to have lodged a complaint to the RCVS about Oxfordshire veterinary surgeon Chris Day, following his acquittal by a district judge in Hemel Hempstead Magistrates Court in December 2001.
The owners of the dog involved were charged with permitting unnecessary suffering and Mr Day with causing unnecessary suffering under the Protection of Animals Act 1911.
On the 12th day of that hearing the judge found in favour of all three defendants, stating that they had no case to answer.
The judge described the owners as exemplary and told Mr Day he could leave the court "with head held high and without a stain on his reputation". He was granted costs from central funds.
The prosecution, which involved the RSPCA, did not appeal against the judgment.
It is usual for disciplinary proceedings by the RCVS to follow a criminal conviction but the basis for this complaint being taken further is unknown. One source suggested it was a possible attack on alternative medicine as Mr Day is well-known for his use of homoeopathic remedies.
The complaint is being considered by the College's preliminary investigation committee which will decide if any further action is warranted.
Well, there's a lot more to it than that, but as we're being told that this is sub judice and not to talk about it, maybe this isn't the time. However, would it be unreasonable to speculate that it might be quite difficult to persuade lay magistrates that homoeopathy isn't actually medicine when the medical profession accords the delusion such conspicuous diplomatic immunity, and the defendant himself claimed to be an RCVS Recognised Specialist in the subject - backing up this claim with photocopies taken from the then-current edition of the Register, on which a list of "Homoeopaths" appears without comment on the page following the page where the real specialists are listed? It's doubtful if anyone actually pointed out to the Court that in fact the homoeopathic 'qualificatons' awarded by the Faculty of Homoeopaths aren't actually approved by the RCVS even for inclusion in the main Register entries.
This was obviously a bit more than one group of veterinary surgeons could take, and the following appeared a few weeks later.
[Volume 33, no. 9, 17th March 2003, page 2.]
Time for statement on unproven medicines
We read with interest your news item in Veterinary Times of 24th February concerning a complaint lodged by the RSPCA to the RVCS about Chris Day. While I'm sure most veterinarians are fairly dubious of the merits of homoeopathic remedies in animal medicine, we must try to keep an open mind. Certainly, the right to prescribe and/or administer a medicine which we truly believe will be to the animal's advantage, over licensed and more conventional medicines, must be retained. We must all admit to having used unlicensed preparations which we believed offered advantages over other methods of treatment.
This right, however, must be weighed against the danger of using an unproven preparation, the action of which has no known scientific basis. One of us (JN) was unfortunate enough some years ago to attend an "outbreak" of parvovirus in a domestic family of five shelties. The well-meaning owner, not for any monetary reason, had accepted the word of a veterinary surgeon from the home counties that he could supply an effective homoeopathic parvovirus vaccine! This was supplied by post (!) and administered to all the dogs by the owner. She was, needless to say, devastated to watch as the disease developed, confirming my assertion that there can be no such thing as a safe and proven homoeopathic vaccine. The pharmaceutical industry is forced by law to spend millions proving the safety and efficacy of any new product. Excessive legislation has caused the withdrawal on economic grounds of literally hundreds of useful existing products, well and truly "proven in the field".
The Royal College must now make a clear and unambiguous statement on where it stands in relation to all unproven medicines, whether homoeopathic, herbal or pharmaceutical. There should be no difference between pharmaceuticals and "alternatives". If an unproven medicine has been administered by a veterinary surgeon to the detriment of an animal, he should be called upon to justify his actions. Let us urge the College not to duck the issue.
JOHN R. NEWCOMBE, BVetMed, MRCVS, and
We couldn't agree more with the final paragraph. However, the RCVS has resolutely refused to make any statement on the matter, and if that had been the end of the correspondence, it would probably have been forgotten in a week or two. However, a couple of homoeopaths couldn't leave (relatively) well alone, and in another three weeks the real fun started.
[Volume 33, no. 12, 7th April 2003, page 16.]
Homoeopathic remedies 'well proven'
The letter from John Newcombe and others in your issue of 17th March contained several errors of fact that should be corrected. Firstly, I would dispute the statement that most veterinary surgeons are dubious of the merits of homoeopathy. There are increasing numbers of members of the RCVS coming forward for training in the discipline, and many others who are increasingly making use of the services of those who have some expertise in the subject. There is a professional qualification in homoeopathy that is recognised by the Royal College.
In my contacts with professional colleagues as a result of being in largely homoeopathic practice, it is a long time since I have had any reaction except support and interest for my involvement in their cases. It is also untrue to claim that homoeopathy has no scientific basis. Such a claim could only be made by someone who has not studied the subject in any depth. I would be happy to direct their reading in an appropriate direction. Modern research is increasingly finding that the ideas of homoeopathy and conventional medicine are working from the same scientific base.
The subject of protection from disease using homoeopathy is a very contentious area, even within the discipline. However, one instance of abuse should not be enough to condemn the whole therapeutic method. If this is to be the criterion, then there would be no vaccination of animals at all! Homoeopathic remedies are subject to the current legislation, as are all other medical preparations. I am in complete agreement with the authors that our right to prescribe what we feel best for our patients must be protected and retained. However, homoeopathic remedies have been well proven over many years in both blind trials and in clinical audit, and so their plea to the Royal College would not apply to them.
J. G. G. SAXTON, BVetMed, MRCVS,
Bellavite, P and Signorini, A. The emerging Science of Homoeopathy.
Schoen, A. and Wynn, S. Complementary and Alternative Veterinary Medicine: Principles and Practice.
This breathtaking letter was almost single-handedly responsible for the current incarnation of the Voodoo Society.
Mr. Saxton's other areas of expertise may be of interest to readers. Unfortunately only the title page is accessible on-line, but he has published in the Radionic Journal (March 2001 volume 46 no. 3, page 11), on "Pure Energy Medicine - Radionics and Pranamonics". Perhaps he will enlighten us some day regarding the scientific basis of these disciplines, and how well they perform in blind trials?
Mr. Saxton also seems to understand that, despite his assertion to the contrary, the 'qualifications' awarded by the Faculty of Homoeopaths are not recognised by the RCVS. Although he holds the highest level of award, the VetFFHom, he quite correctly omits this from his signature, presumably understanding that it is improper to use an unapproved qualification along with the designation 'MRCVS'.
In the same issue, however, a rather more cautionary note was struck.
[Volume 33, no. 12, 7th April 2003, page 16.]
'No such thing as alternative medicine'
I am writing in support of the letter in the issue of 17th March entitled Time for statement on unproven medicines. I couldn't agree more with the points raised concerning homoeopathy and other alternative treatments. We really do need to adopt a rather less credulous and more open-minded, sceptical position on such things if we are to retain any credibility as a profession in these days of evidence-based medicine. The number of "alternative" therapies seems to be increasing at an exponential rate (although as a Glastonbury resident this may be a less than unbiased opinion!) and now includes such things as kinaesthesia and dowsing for food allergies, animal reflexology, distant healing, energy field manipulation and so forth as well as the better-known techniques of homoeopathy, crystal healing and acupuncture.
There are a variety of websites (such as www.healthwatch-uk.org, a registered charity, and www.quackwatch.org) dealing with these unproven treatments in the human medical field and both provide links to research papers and articles on the subject. As yet I have been unable to find any firm, properly conducted, blinded research that suggests any benefit from complementary or alternative methods in either human or veterinary medicine, although I remain open-minded. Obviously, if there ever is scientific (rather than anecdotal) evidence that any of these treatments were effective, this would have immense significance, not just in the medical field but also in the wider fields of physics and other sciences. For instance, explanations would need to be sought for how homoeopathy is able to effect treatment when the remedies are so diluted that the chance of receiving even one molecule of the original ingredient is infinitesimally small. Research and discussion, however, must focus initially on the basic question of whether any of these therapies work; until then, alternative practitioners will lay themselves open to question. Speculation as to possible mechanisms of action (such as the discredited memory of water research by Jacques Benveniste) are largely irrelevant if effectiveness has not yet been confirmed. I for one would welcome good research into any or all of the so-called alternative therapies because at the end of the day there is no such thing as "alternative" or "conventional" medicine, there is only good medicine and bad medicine.
NIALL TAYLOR, BVM&S, MRCVS,
A few weeks later this further contribution appeared on the pro-homoeopathy side. Unlike Mr. Saxton, Mr. Hoare apparently doesn't appreciate the etiquette surrounding unapproved 'qualifications' and one's MRCVS status.
[Volume 33, no. 15, 28th April 2003, page 7.]
In defence of homoeopathy
I would like to confirm Mr. Saxton's defence of homoeopathy (7th April issue). The number of veterinary surgeons who are investing their time, money and energy in the study of homoeopathy is slowly but steadily increasing.
The number of clients who use homoeopathic medicines to treat their animals is also growing, and they would rather be advised by veterinary surgeons trained in the discipline than by lay practitioners.
For those like Mr. Taylor who have been unable to find any firm, properly conducted, blinded research, may I direct their attention to the work of Kleijnen (1991), Boissel (1996) and Linde (1997). I do hope though that their minds are more open than was Kleijnen's when he concluded: "The amount of positive evidence even among the best studies came as a surprise to us. Based on this evidence we would be ready to accept that homoeopathy can be efficacious, if only the mechanism of action was more plausible."
For those who require evidence of the efficiency of homoeopathy in clinical usage, I would refer them to Clover (2000), Richardson (2001) and Spence (2000). As Mr. Taylor said, "there is only good medicine and bad medicine". Without doubt, homoeopathy comes in the former category.
JOHN HOARE, BVSc, VetMFHom, MRCVS,
Boissel et al. (1996) Report to European Commission, Brussels, Homoeopathic Research Group, Chap, II: 195-210.
Clover, A. (2000) Patient Benefit Survey, Tunbridge Wells Homoeopathic Hospital. B. Hom. J. 89 (2): 68-72.
Kleijnen et al. (1991) Clinical trials of homoeopathy. British Medical Journal 302: 316-323.
Linde, K. et al. (1997) Are the clinical effects of homoeopathy placebo effects? Lancet 350: 831-843.
Richardson, W. (2001) Patient benefit survey: Liverpool Regional Department of Homoeopathic Medicine. B. Hom. J. 90: 158-162.
Spence, S. (2000) Clinical Outcome Audit: Bristol Homoeopathic Hospital. B. Hom. J. 89 (Supplement 1): 44.
The three references which are not from the British Homoeopathic Journal (now Homeopathy, a deeply strange publication) are among those considered (or should that be "shredded"?) by Prescrire International (1996), Wagner (1997), Ramey (2000), Barrett (2002) and Ernst, 2002. Bandolier has a particularly thorough look at the Linde meta-analysis.
This was pretty much guaranteed to stir up the evidence-based medicine contingent (99.3% of the profession at the last count, but in general less vocal). However, summer was well and truly ycumin in before they really got into their stride. Bob Plenderleith arguably had the best approach, though the two-edged nature of his final sentence provided food for thought....
[Volume 33, no. 19, 26th May 2003, page 3.]
Time to treat subject with seriousness...
I am writing to point out that those writing with reference to homoeopathy have forgotten to mention (a) Aesop's Fables and (b) Hans Christian Andersen's fairytales as possible sources.
I also hope the Competition Commission did not comment on the rising price of water! I really think it is time our profession started treating this subject with the seriousness it deserves.
ROBERT W. PLENDERLEITH, BVMS, MRCVS,
This was also the point at which the rapidly re-awakening Voodoo Society decided to pitch in. Following a strong hunch that a pretty fair proportion of the above-mentioned 99.3% of the profession didn't have much of a clue what the homoeopaths were on about, we decided it was time for a tutorial.
[Volume 33, no. 12, 26th May 2003, pages 3-4.]
'Extraordinary' claims of homoeopathy...
Niall Taylor (Letters, 7th April) remains open-minded about homoeopathy, and calls for more research into the subject. Superficially this sounds sensible, and it certainly sidesteps the possibility of one almighty row, but is it really such a rational position?
Unlike the amount of homoeopathic remedy which may be made from a few grammes of raw material, research funds are not infinite. Should we really consider diverting a portion of a scarce resource into investigating the therapeutic potential of water or lactose, which, no matter what random impurities might be present, often contain not a single molecule of the alleged active principle, (which may be something like ground-up honey-bee, or bitches' milk)?
Homoeopathy is not herbalism, and this is not a question of extract of willow bark for headaches or tincture of foxglove for heart disease. Nor is it the accumulated wisdom of centuries of empirical observation - it was dreamed up by one man in the early 19th century. Let us remind ourselves just what is being claimed.
There's more, but this is the central tenet and basic technique of 'drug' manufacture. Does this really sound like a rational focus for research effort?
One concern is that classical homoeopathy is not concerned with diagnosis. The choice of remedy is based on the presenting signs, therefore underlying cause is a secondary issue. Secondly, the 'like cures like' principle governing the choice of remedy is at best simplistic, and seems to have no basis in what we know of medicine today. Why should a weak solution of onion cure any disease which presents with runny eyes and nose? Thirdly, the principle of ultramolar dilutions, which is an entirely separate concept from 'like cures like', requires the postulation of some as yet undiscovered property of matter in order to suggest a mechanism of action. Even if there were some basis to the selective "memory of water" hypothesis, it is hard to see how this might be enhanced as dilutions become weaker, or maintained during absorption, and if it were, how any such structure could influence cell metabolism.
"But it works!" we're told. Does it? Another notable quality seems to be that the therapeutic effect is striking and unmistakable at the level of the individual anecdote, but shyly retreats to the borders of statistical significance in larger-scale trials. Contrary to J. G. G. Saxton's assertion, modern research is NOT "increasingly finding that the ideas of homoeopathy and conventional medicine are working from the same scientific base". No reputable immunologist believes that any hitherto unsuspected property of the immune system is being activated by this bizarre preparation method, and there is no body of either blind trial or clinical audit in either human or veterinary medicine which could by any stretch of the imagination be said to ratify the remedies as 'well proven'.
The claims of homoeopathy are so extraordinary that I can understand the feeling that only trials conducted by 'non-believers' can really be trusted to be free from bias, and that perhaps we owe it to the public to generate some objective data. Nevertheless, is it really likely that such an approach will have any effect? People have been publishing credible refutations of homoeopathic methods almost since the discipline was invented (Holmes, 1842). Aggregations of studies from the human literature, including all three articles cited by John Hoare (28th April issue) as "firm, properly conducted, blinded research", have struggled to find more than the most marginal of statistically significant findings (Wagner, 1997; Ramey, 2000). An edition of Horizon (BBC2) broadcast in December 2002 featured a closely-supervised attempt to replicate an experiment with highly diluted histamine, which was at one time hailed as 'proof' of homoeopathy's basic tenet. The results were totally random. Most recently, a study of asthmatic children in Somerset found no difference between a homoeopathic remedy and a placebo (White et al., 2003). These widely-publicised findings don't seem to have put even a crimp in the homeopaths' faith. Is there any reason to believe that further similar trials will be any more closely heeded?
Homoeopathy has had two hundred years to produce convincing evidence of efficacy (and, incidentally, suggest a plausible mode of action), which it has singularly failed to do. Even in the studies which are claimed as positive, the effect demonstrated is either so marginal as to be clinically insignificant, or irreproducible - usually both. In contrast, over the same period evidence-based medicine has produced enormous advances which have transformed the lives of human and animal patients alike. Are we still advocating an 'open-minded' approach to the question of the efficacy of insulin in diabetes mellitus, for example? Of course not. An open mind is an admirable approach to a new idea, but persistent refusal to make up one's mind when abundant information is available is simply evasive.
Technically, homoeopathy has far more in common with what anthropologists term 'sympathetic magic' (Frazer, 1922) than with science. The central tenet, 'similia similibus (curentur)', is an expression of a general magical principle which equally describes such practices as voodoo or puppet healing.
Rather than calling for more research, should we not be questioning the wisdom of sanctioning a discipline at all? Are the veterinary schools wise to invite homoeopathic practitioners to lecture to undergraduates, presumably to allow the students to realise the improbability of the claims at first-hand, when the result is that these practitioners then claim they are recognised teachers of an accepted academic discipline? Is the RCVS wise to maintain a list of holders of homoeopathic 'qualifications', which are not approved for inclusion in the Register itself, when this is then represented as recognition of the qualification and the discipline by the College? Is the prospect of an actual confrontation within the profession so unthinkable that we have to maintain this polite fiction of the open mind to avoid asking the emperor precisely where he might have misplaced his wardrobe?
MORAG KERR, BVMS, BSc, PhD, CBiol, FIBiol, MRCVS,
FRAZER, J. G. (1922) Sympathetic Magic. Ch. 3 of The Golden Bough, a Study in Magic and Religion, 4th edn. Public domain text, several editions in print.
HOLMES, O. W. (1842) Homeopathy and its kindred delusions. In Examining Holistic Medicine, ed. D. Stalker & C. Glymour, 1985. New York: Prometheous Books.
RAMEY, D. W. (2000) The scientific evidence on homoeopathy. Priorities for Health 12, 19-21, 40.
WAGNER, M. W. (1997) Is Homeopathy 'New Science' or 'New Age'? Scientific Review of Alternative Medicine 1, 7-12.
WHITE, A., SLADE, P., HUNT, C., HART, A. & ERNST, E. (2003) Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial. Thorax 58, 317-321.
The third letter in the sequence was a second contribution from Niall Taylor, with a nice summary of the perceptive Why Bogus Therapies Seem to Work.
[Volume 33, no. 12, 26th May 2003, page 4.]
... and a complete absence of evidence
Re: "In defence of homoeopathy" (28th April issue)
I cannot see why the fact that increasing numbers of clients using veterinary homoeopathic remedies should be an indication of the safety or effectiveness of such remedies.
Millions of people read their horoscopes every day and are able to rationalise the vague predictions to fit their experiences, but that doesn't validate astrology.
Many dubious health products remain on the market primarily because of reports from satisfied customers. Essentially, they are saying: "I tried it and I got better, so it must be effective." But even when symptoms do improve following a treatment, this, by itself, cannot prove that the therapy was responsible - correlation does not imply causation.
There are a number of sound reasons why homoeopathic or placebo treatments may appear to be effective in animals despite the impossibility of a true placebo effect per se: (a) the disease may have run its natural course; (b) many diseases are cyclical; (c) spontaneous remissions; (d) misdiagnosis by owner or veterinary surgeon; (e) the concurrent use of an appropriate pharmaceutical (so-called complementary medicine) allowing the homoeopathic remedy to claim success; (f) a desire to believe on the part of owners - even when there are few if any improvements in the treated animal, owners who have a strong psychological investment in alternative medicine can convince themselves they have been helped.
To have received no relief after committing time and money to, and often having a deep, personal belief in alternative treatment is difficult to admit to oneself and others so there is strong pressure to find some redeeming value in the treatment l. It is this last reason that is perhaps most concerning to me, as without correct clinical guidance there are welfare implications hereanimals cannot make an informed choice.
As I said in my original letter, anecdotal argument is entirely irrelevant; proper trials for efficacy and safety are needed. Many studies have been conducted from scientific papers and analyses to the recent Horizon programme (BBC2, November 2002), which consistently fail to show any significant effect of homoeopathy.2, 3, 4, 5, 7
The recurring theme is that the better the methodological quality of the trials, the less likely it is that results in favour of homoeopathy will be seen and that further research is required. This includes the meta-analysis6 mentioned by Mr Hoare in support of homoeopathy, which found that most of the trials looked at were of low methodological quality and possibly subject to publication bias.
Proponents of homoeopathy and other "alternative" treatments must be prepared to accept the results of all proper research, not simply that which supports their beliefs. At the moment there is a complete absence of evidence for any significant effect of homoeopathy. For anyone willing to take a rational, disinterested view on this subject and anxious to learn more about scientific research into alternative treatments, I would recommend visiting the website for the task force for veterinary science at www.vet-task-force.com.
NIALL TAYLOR, BVM&S, MRCVS,
The following week Sasha Farr added another example of the parvovirus 'nosode' scandal, quite similar to the case which started the correspondence thread back in February.
[Volume 33, no. 13, 2nd June 2003, page 8.]
Homoeopathic vaccine led to puppy deaths
Just to put in my two pence worth regarding homoeopathy. Never have I been so frustrated after losing five out of nine infected Lhasa Apso puppies from two different litters with diagnostically confirmed parvovirus. The breeder had vaccinated them, as per the instructions, using a homoeopathic vaccination that was recommended by other breeders and bought from a large company in London.
Such meaningless suffering and death due to exploitation of a breeder's ignorance leaves me aghast. The ludicrous idea that homoeopathy plays a part in canine vaccination makes me quite ill.
SASHA FARR, BVSc, MRCVS,
This makes the third time this has been reported, because as well as the letter from John Newcombe and his colleagues which kicked off this sequence, we're counting the one from Hal Thompson (that's Professor Hal Thompson of Glasgow University, who quite possibly knows more about parvovirus than anyone else alive) published in the Veterinary Record on 26th October 1991, which itself described several apparently unrelated incidents. Oh, what the heck, let's just reproduce that one as well. It was part of a very similar correspondence thread to the present one, with rather more emphasis on whether or not homoeopathic remedies should be licensed in the same way as other pharmaceuticals. If you want to read the whole thing, go find a good library!
[Veterinary Record, vol. 129, 26th October 1991, page 390.]
From Dr H. Thompson
SIR,- I would take issue with Mr Coode's suggestion that homoeopathic remedies should not be subject to the same controls as convenional medicines (VR, October 12, p342). If you charge the customer for your services then surely you have a responsibility to ensure that the products you sell are what they claim to be. I refer in particular to homoeopathic vacines for dogs and cats. In the last three weeks I have confirmed parvovirus infection in two dogs and a cat said to have received such vaccines. Who monitors adverse reactions including lack of efficacy? Who will decide to withdraw the products if deaths occur?
These vaccines would not sell without their 'parvovirus' association. But what homoeopathic principle underlies their manufacture? After a previous incident I contacted the homoeopathic pharmacy involved and was referred to the veterinary surgeon who had supplied the material for the vaccine. He had not made the diagnosis of parvovirus infection himself in the dog, a Yorkshire terrier, from which material was collected, but rather had relied on the diagnosis of another veterinary surgeon. He did not know how or if the original diagnosis of parvovirus infection had been confirmed. In other words, the source material for the homoeopathic vaccine could just as easily have come from a case of salmonellosis or coronavirus infection as parvovirus infection.
If you stood on the street corner claiming to sell Rolex watches when in fact you were selling pencil sharpeners you might have trouble with the law. Can someone explain what makes selling homoeopathic parvovirus vaccines different?
This in fact makes a subtly different point. The 'nosode' investigated by Professor Thompson turned out not to have been prepared in the way that it ought to have been prepared, that is by using material from a confirmed case of the disease. Which of course makes a telling point regarding the licensing question. The even more important question of whether there would be any efficacy to demonstrate even if the preparation were to be done exactly in accordance with the instructions is nevertheless left hanging ominously in the air.
The letters published on 26th May (remember these? - Plenderleith on fairy tales, Kerr on homoeopathic principles and Taylor on why bogus therapies seem to work) elicited the following 1,800-word tirade, which pretty much defies comment.
Mr. Gregory obviously appreciated the justice of Bob Plenderleith's criticism of his reference list, and he has rectified the matter in his final paragraph.
[Volume 33, no. 22, 16th June 2003, pages 7-8.]
Homoeopathy 'doesn't need proof'
At last some honesty in the debate on homoeopathy; your correspondents (26th May issue) leave no doubt as to where they are coming from and what they are seeking.
As a veterinary surgeon of 30 years' experience, half of them involved with homoeopathy, I have long been intrigued by the violent opposition which this system of medicine engenders in those who have never fully investigated it.
The emotive language used by its opponents goes far beyond that of any scientific debate and has led me to believe that the issue is rather one of politics and belief systems.
Letters from your recent correspondents are laced with words such as "impossibility", "irrelevant", "magic" and "voodoo" hardly the vocabulary of rational debate. In the field of psychotherapy, it is generally accepted (though not proved by double-blind trials) that the language used by an individual indicates much about the hidden issues which underly the debate.
Usually, insults are a way of covering over a feeling of being threatened and I have taken some time considering why homoeopathy is considered by some to be such a threat that rational argument and objectivity are left by the wayside. Unfortunately, I have also concluded that true objectivity is unattainable for most of us. We all have viewpoints and opinions to which we cling in order to reinforce our feeling of self worth.
My own history is that having studied homoeopathy and given it what I considered to be a fair trial, i.e. by using it, I was convinced of its efficacy. I am not alone in this: there are many thousands of intelligent, sensible, rational-thinking doctors and veterinary surgeons around the world who have investigated homoeopathy, tried it out and now practise it to the benefit of their patients.
I have personally found homoeopathy to be so effective that for the last seven years I have made my livelihood in referral practice using homoeopathy, at times supplemented by acupuncture. Most of my clients are intelligent, rational middle-class people who are simply looking for the best treatment for their animal. They usually come because they know of someone whose animal has benefited from homoeopathy or because they themselves have benefited from homoeopathy. They stay, because they observe the benefits which the majority of my patients experience.
To suggest, as does Mr Niall [he means Niall Taylor], that I and they are incapable of making a judgment of whether or not the therapy has benefited the patient is at the least condescending and at the worst offensive. The qualification I hold was awarded to me in 1991 after rigorous examination by a body instituted over 50 years ago by an Act of Parliament, the Faculty of Homoeopathy.
Homoeopathy is a recognised speciality within the medical profession. The principle has been recognised since ancient Greek times and homoeopathy in its present form has been practised without a break since its formulation 200 years ago by a German doctor, Samuel Hahnemann. This system of medicine was developed by meticulous experimentation; it was not "dreamed up". Well ahead of his time, Hahnemann identified the ill-effects of public health and hygiene and postulated a version of the germ theory.
Homoeopathy has developed considerably since Hahnemann's time and the form in which it is now practised indeed represents the accumulated wisdom of two centuries of empirical observation. The history of veterinary homoeopathy runs parallel to that of medical homoeopathy. There are few countries where veterinary homoeopathy is not practised, and in the UK there are burgeoning numbers of practical, hard-headed farmers, not always farming organically, who use homoeopathic medicines because they find them to be effective.
Is it really rational to propose that homoeopathy "doesn't work"? The question is not whether or not homoeopathy works, but how and why it works. The process of manufacturing potentised medicines indeed requires the postulation of a property of matter which is not explained by materialistic Newtonian physics, but that world view is 80 years out of date.
Einstein and his successors in the "new physics" have described properties of matter and energy which demand a different perspective; matter and energy are interchangeable and indeed one and the same. I personally have no doubt that the enigma of the potentised remedy will be solved within the paradigm of quantum mechanics.
Of course, one of the fascinating discoveries of those working in this field has been that at the subatomic level it is impossible to separate the effects of the presence of the observer from the results of an experiment: there is no such thing as objectivity; the mere presence of the observer has an effect in determining the results of the experiment.
If homoeopathic medicines have an effect at this level, and given their method of preparation it seems logical that they do, then it is not rational to conduct experiments using designs formulated for the examination of relatively large, material doses of chemical drugs. Of course it matters not how much evidence is gathered to support this proposition, no one is going to change his or her mind; to this day there are still those who believe that the Earth is flat.
But is it rational to believe that at this point in history we know everything there is to know about the universe? Just because we don't understand why potentised medicines have an effect doesn't mean they have none, and if a popular television programme cannot replicate the results of an experiment which has been validated in several other scientific establishments around the world, then the most obvious conclusion is that they did something wrong. It is not proof or disproof of the "memory of water", and has no relevance whatsoever to the validity of the homoeopathic method.
Far from being a quaint anachronism, homoeopathy is at the cutting edge of 21st century scientific investigation; to those rooted in the 19th century reductionist paradigm into which we have all been educated, and within which we live our daily lives, this may indeed be threatening, but further threats loom over the horizon: when one has experienced the validity of homoeopathy, one is obliged to look critically at many of the procedures in general veterinary practice which run contrary to homoeopathic rationale.
One has to question the need for and safety of annual booster vaccinations and the desirability of feeding highly-processed "complete" pet foods, and one finds oneself dispensing medicines which cost a few pence per tablet (and many of which are available over the counter from homoeopathic pharmacies and health food shops) rather than expensive POMs.
These are the mainstay of most veterinary practices: no wonder some of our colleagues feel threatened. If left unchecked, homoeopathy might even threaten the stranglehold which the large drug companies have over our profession - scary indeed.
Fortunately, the practice of homoeopathy for animals is legally confined to veterinary surgeons; the patients of veterinary homoeopaths benefit from all the diagnostic procedures appropriate to good veterinary practice. However, the veterinary surgeon then has a choice of which therapy is most suitable for the individual patient.
It is indeed wise of the Royal College to advise that anyone practising homoeopathy should be properly trained. Were these controls to be relinquished, there would truly be a welfare issue.
There is a massive ground-swell of animal owners seeking homoeopathy for their charges. Even now, because of the relatively small number of veterinary surgeons qualified in homoepathy, many animal owners seek prescriptions from homoeopathic pharmacies and non-medically-qualified homoeopaths.
The increasing numbers of companion animal owners and livestock farmers who are seeking homoeopathic medicine makes it a matter of urgency for the profession to train more veterinary surgeons in the modality; I am pleased to report that those of us who are involved in teaching homoeopathy to the profession have a steady stream of applicants.
The universities are also beginning to recognise this and deserve credit for their forward thinking in at least making students aware of alternative therapies. As one who has had the privilege of addressing such an audience, I have to admit I was pleasantly surprised by the lively interest and open-mindedness of the students with whom I engaged.
It is my personal view, though not that of many of my colleagues, that it would indeed be a waste of time and money trying to "prove" whether homoeopathy "works" or not. No amount of placebo-controlled crossover trials is going to convince me that the effects of homoeopathy, which I observe daily in practice, are a delusion. Similarly, no amount of evidence will convince the opponents that it works, and I am pleased that your recent correspondents are so open about their motives.
Ms Kerr [that's "Dr. Kerr" to you!] considers homoeopathy to be ludicrous and admits that her open mind, like the emperor's new clothes, is a polite fiction, while Mr. Taylor [ah, at least his name is correct this time] subscribes to the veterinary task force web site, which is a member of the "Anti-Quackery Ring". So not much objectivity there, then. (Interestingly, the website makes no mention of the many veterinary trials into homoeopathy which have been conducted around the world and confines its critiques to medical papers.)
Zen Buddhism considers the principle of "small mind" and "big mind". "Small mind" is that which we use in everyday life and focuses on the immediate and the mundane. It is the mind which reacts in the way in which it has been conditioned, and sees only the immediate and superficial.
"Big mind" is a raised consciousness which sees the bigger picture and recognises the underlying issues of which we are unaware when we function in the "small mind". It is the function of the Royal College to employ the "big mind", and I am confident that it will continue to do so, but make no mistake, this issue is as unresolvable as any political or religious difference. It has run for 200 years and will continue to do so for a good while yet.
The best we can do is recognise that we have different opinions and experiences, and accord each other the respect that membership of our profession demands; there are enough enemies out there without creating divisions within our ranks, and our profession is certainly big enough to accommodate many different viewpoints.
In conclusion, may I remind your correspondents of the words of the Buddha: "Do not accept anything which is unreasonable - but do not reject anything as unreasonable until you have investigated it fully."
Oh yes - and don't forget the tortoise and the hare.
PETER GREGORY, BVSc, VetMFHom, CertIAVH, MRCVS,
It's very tempting to retaliate by psychoanalysing the motivation of qualified professionals who abandon their education and espouse popular magical beliefs, but we won't descend to Mr. Gregory's level just at the moment. However, if he's really interested in what motivates professional criticism of homoeopathy, it's no big secret. Absolute outrage at the fact that professional colleagues are using their qualifications to promote bogus and ineffective 'medicine', and are being allowed to get away with this by both the RCVS and the VMD.
This lot is pretty much par for the course, really. After accusing critics of emotional outbursts and rudeness, we're told that anyone who doesn't agree that homoeopathy is good medicine hasn't investigated it, knows nothing about it, and is biassed and closed-minded. Interesting that mere membership of an 'anti-quackery' web ring, that is a group of web sites devoted to investigating bogus medical claims, is by itself considered sufficient grounds for dismissing everything said there. Then we hear once again that "it works!", side-track into a discussion of the problems of scientific medicines, and invoke any sort of weird philosophy handy to imply that some scientific or mystical mode of action may yet be elucidated. Specific points of criticism are, as usual, completely ignored.
Then, without a pause for breath, we were off again the very next week. Mr. Hoare also addresses the question of Aesop and Hans Christian Andersen, then goes on to challenge me to a duel!
[Volume 33, no. 23, 23rd June 2003, page 4.]
Homoeopathy: fables and fairy tales?
I wish to point out to Mr. Plenderleith (26th May issue) that while I am pleased to learn that he has a wide range of literature in his practice library, neither of the two volumes he mentions 1, 2 are peer-reviewed journals, nor do they contain any reference to random controlled trials. Dr Kerr's letter in the same issue shows that she has not fully understood any writings by homoeopaths she has read. Admittedly, Dr Hahnemann's first experiments with Peruvian bark extract were carried out using material doses (Cullen, 1790) 3, but he gradually reduced the size of the doses used in both proving medicines and treating patients. By 1833 he was recommending that the 30 cH dilution should be used for all provings.
Regarding "similia similiblus curentur", Dr Kerr states that it seems to have no sensible basis in what we know of medicine today; but the basis of Jenner's original vaccination was the use of cow pox virus to protect against small pox. That surely is like prevents like, and it can be argued that modern vaccines, although derived from the pathogens, have been modified/attenuated enough in the laboratory to count as similars.
The dermatologists' use of desensitisation by the injection of a small amount of the particular allergen involved is isopathy rather than homoeopathy according to purists, but the principle is very similar. When the use of material quantities of medicinal agent is under consideration, then the use of Vaseline (petroleum jelly) on dry, cracked skins is yet another instance of homoeopathy in action.
She states that "only trials by 'non-believers' can really be trusted to be free from bias". Is she prepared then to participate, along with another nine non-believers of her choosing, preferably including Mr Plenderleith and Mr Taylor, in a re-proving of the 30th cH potency of a well-known homoeopathic remedy, the results of which can he compared with the 1833 Materia Medica 4? The proving is to be conducted according to the directions laid down by Hahnemann in the 6th edition of the Organon 5. Final details of the challenge (homoeopathic tablets at 12 hourly intervals), its monitoring, assessment, etc., can be arranged by our Seconds. Mr. G. R. S. Johnson will represent me, and can be contacted at 8 West Road, Wiveliscombe, Taunton, Somerset, TA4 2TF.
I would also like Mr. Taylor to explain why the factors mentioned in paragraph four of his letter in the same issue of Veterinary Times apply only to homoeopathic trials and not those using pharmaceuticals.
JOHN HOARE, BVSc, VetMFHom, MRCVS,
Well, this is where it really started to get interesting. As usual, one error or misunderstanding is jumped on to dismiss or ignore an entire volume of rational criticism. However, what an interesting misunderstanding! Virtually all explanations of homoeopathy for the non-expert state either explicitly or implicitly that the 'provings' are done on real amounts of substance. Even on the famous Horizon broadcast, Peter Fisher explained the similia similibus principle by recalling that chopping an onion makes one's eyes water. He never mentioned what homoeopaths believe might or might not be experienced by healthy people taking a 30C preparation of onion, or explained that this was the important consideration. However, far from clarifying matters, this surely serves merely to make the whole edifice even more preposterous than ever.
Of course, my own letter was referring to a clinical trial which could be properly blinded, and in which the response of the patients would be assessed by non-advocates of homoeopathy. Not to a trial in which the advocates suggest to non-believer guinea-pigs what responses they might be experiencing! However, the information that the proving effects are themselves magical rather than physiological opens a whole new vista of possibilities. Clinical trials of homoeopathy are fraught with difficulty. Some patients improve, some don't, and the outcome is always the same. The homoeopaths find something sigificant (usually at p<0.05) to brag about, while the scientists declare that there's nothing there. Looking instead at the provings should provide a much more standardised situation to assess whether ultradilute solutions have any physiological effect, and all we really need to do is design a suitable protocol.
In fact this sort of exercise has been done several times, and reported in refereed journals - with uniformly negative results. Relevant references include:
GOODYEAR, K., LEWITH, G. & LOW, J. L. (1998) Randomized double-blind placebo-controlled trial of homoeopathic 'proving' for Belladonna C30. J. R. Soc. Med. 91(11), 579-82.
VICKERS, A. J., VAN HASELEN, R. & HEGER, M. (2001) Can homeopathically prepared mercury cause symptoms in healthy volunteers? A randomized, double-blind placebo-controlled trial. J. Altern. Complement. Med. 7(2), 141-8.
WALACH, H. (1993) Does a highly diluted homeopathic drug act as a placebo in healthy volunteers? Experimental study of Belladonna 30C in a double blind crossover design - a pilot study. J. Psychosomatic Res. 37(8), 851-860.
WALACH, H., KOSTER, H., HENNIG, T., & HAAG, G. (2001) The effects of homeopathic belladonna 30CH in healthy volunteers - a randomized, double-blind experiment. J. Psychosomatic Res. 50(3), 155-160.
And since that letter appeared, another similar study has been published:
BRIEN, S., LEWITH, G. & BRYANT, T. (2003) Ultramolecular homeopathy has no observable clinical effects. A randomized, double-blind, placebo-controlled proving trial of Belladonna 30C. Br. J. Clin. Pharmacol. 56(5), 562-568.
That week I was contacted by quite a few colleagues eager to get involved in Mr. Hoare's exercise, but as Niall remarked, what would be the point? What would there be to prevent a bunch of determined sceptics from simply denying that they felt anything, no matter what they might experience? Mr. Hoare seems to think the effects are so compelling that we coudn't help but believe. Frankly, we beg leave to doubt this, especially in the light of the papers cited above, three of which actually involve Mr. Hoare's own chosen preparation. However, if such striking effects really do occur, we'd much prefer that the homoeopaths, who presumably know what they're looking for, demonstrated that they could detect them themselves.
A much more interesting exercise would be to revive the aborted trial described by Oliver Wendell Holmes. He recorded that "In 1835 a public challenge was offered to the best-known Homeopathic physician in Paris to select any ten substances asserted to produce the most striking effects; to prepare them himself; to choose one by lot without knowing which of them he had taken, and try it upon himself or an intelligent and devoted Homeopathist, and, waiting his own time, to come forward and tell what substance had been employed. The challenge was at first accepted, but the acceptance retracted before the time of trial arrived."
If Mr. Hoare can really do this with ultramolar dilutions he would undoubtedly qualify for the JREF Challenge million dollar prize. Surely the best way to settle this is for him to make a formal application for the prize, and the best of luck to him? Mr. Gregory blamed Horizon's failure to win the same prize for their attempt to duplicate the 'Benveniste effect' on their having "done something wrong". However, applicants for the prize are allowed to design their own protocols, subject to approval, and if Mr. Hoare himself were to do this then surely he would do it right?
We thought we might sit on that idea for a little to see what else might come out of the woodwork, and indeed the fun continued. It seems that Mr. Gregory sent off the 1,800-word rant above before he saw Sasha Farr's letter, and couldn't resist having a go at her as well.
[Volume 33, no. 23, 23rd June 2003, page 4.]
Need for rational consideration of issues
May I correct Ms Farr with regard to "homoeopathic vaccinations" (2nd June issue). The use of potentised disease products for the treatment or prevention of a named disease is correctly termed "isopathy" (from the Greek iso meaning "the same as") and while often considered to be part of the system of homoeopathy, it is, strictly speaking, a separate discipline. The correct term for a potentised medicine made from disease products or the causal agents of infectious disease is a "nosode".
There is evidence1,2,3 that in the face of an outbreak of disease, or in a herd situation where disease is enzootic, the use of nosodes will reduce the morbidity and mortality in a population, and this is an increasingly common practice on organic dairy farms, where nosodes prepared from the major pathogens are administered as part of the strategy for the control of mastitis. However, the administration of nosodes to a healthy individual in an attempt to prevent diseases such as distemper and parvovirus, and as a substitute for conventional vaccination, is contentious, within the fields of both medical and veterinary homoeopathy. Certainly no antibody response can be detected, though I understand that neither does conventional leptospirosis vaccine induce measurable antibodies.
As a simple veterinary issue, the selection of preventive regimes for the major infectious diseases of animals is one which requires the experience and knowledge of a veterinary surgeon, and the consequences described by Ms Farr are exactly those which may ensue when the skills of a veterinary surgeon are not involved in the decision-making process. Unfortunately, many veterinary clients fail to seek guidance from their veterinary surgeon on such issues, as they are literally frightened of the response which they may receive when they mention homoeopathy. This adds to the perception that homoeopathy is somehow outside the remit of the veterinary profession and help is sought elsewhere, sometimes with tragic consequences. The sooner we can educate the public into seeking advice on all aspects of animal health from their veterinary surgeon, and remove the distinction between "orthodox" and "alternative", the better for all, and even more rare will be the occurrences such as reported by Ms Farr. The buzz word in the medical profession is "integrated medicine" and this seems to me to be the only rational route for our own profession to follow.
Sadly, it seems ignorance of veterinary homoeopathy has been a factor in the emotional reaction in your correspondent which precludes a rational consideration of the real issues. I can sympathise with this; I well remember my own grief some years ago on losing vaccinated Rottweiler puppies from parvovirus, but my experience did not lead me to believe that orthodox medicine, or vaccination per se was ludicrous.
Once again, your correspondent lacks even a basic understanding of homoeopathy; for those who wish to be better informed there is a wealth of literature available, also visiting the following websites may prove informative: www.bahvs.com, www.trusthomeopathy.org/faculty, www.hptg.org.
PETER GREGORY, BVSc, VetMFHom, CertIAVH, MRCVS,
All right, all right, we know, anyone who thinks that magic (sorry, "energised") diluted water has no therapeutic properties only holds this opinion because of a lack of understanding of homoeopathy, and an emotional refusal to consider its claims objectively. And we should of course have remembered that nosode prophylaxis is part of homoeopathy when the homoeopaths feel like it, but when something goes wrong they immediately remember that it doesn't conform to classical homoeopathic principles. As an aside, surely then Hal Thompson's case, where the nosode appeared to have been prepared from an animal which might only have been suffering from something like parvovirus, was proper homoeopathy and should therefore have been successful? As we already pointed out, this is at least the third virtually identical report of grief resulting from these pestilential nosodes, but why should we ever expect anything but an exhortation not to reject the entire principle because of one single adverse incident? At least when such an incident follows vaccination with a licensed vaccine, we have research to fall back on to justify our generally good opinion of these products, and a reporting system for adverse reactions which should allow withdrawal of an ineffective or dangerous preparation should that be warranted. With the homoeopathic preparations, as was clearly revealed by the Veterinary Record correspondence which followed on from Hal Thompson's letter, there is no research, no standardisation, and no reporting procedure.
The following week Mr. Hoare was back again for a third bite at the cherry, but this time on the tenuously related subject of the King Bio affair. It looks as if the matter of the JREF Million Dollar Challenge will have to wait for a bit. If you're confused (I was), the "thorough study" called for in the letter's title is the study of the tenets of homoeopathy by us non-believers - NOT a thorough study to see whether or not homoeopathic medicines are actually effective.
[Volume 33, no. 24, 30th June 2003, pages 4-6.]
Homoeopathy: call for thorough study
Homoeopathy and fraud
In view of the recent correspondence regarding homoeopathy, I wondered if your readers might be interested in an outline of a recent court case in the USA. The background details are that The National Council Against Health Fraud Inc. (NCAHF) brought a case against King Bio Pharmaceuticals and its president Frank J. King, Jr, for "unfair competition and false advertising", which it lost. The NCAHF claimed that King Bio's advertising claims for 50 of its homoeopathic remedies were false and misleading, in that the products were not effective as claimed. The NCAHF is a private institution that refers to itself as "Quackbusters".
All the following details are taken from a judgment of The Superior Court of Los Angeles County, California, released for partial publication on 22nd April 2003. The full judgment is some 22 pages long and the page numbers are shown in brackets after the headings.
Facts (p. 3). King Bio sells homoeopathic remedies. According to its product labels and website, King Bio's products relieve a variety of symptoms and ills, including: stress, colds, flu, eating disorders, learning disorders, menstrual irregularities, snoring and tobacco and alcohol cravings.
Homoeopathy is a form of alternative medicine. Homoeopathic remedies are manufactured using extremely small quantities of various ingredients. Recognised homoeopathic remedies are listed in the Homeopathic Pharmacopoeia, which is updated by the Homeopathic Pharmacopoeia Convention, a group of homoeopathic practitioners. The Convention will not accept a new remedy for inclusion in the Pharmacopoeia without evidence of its safety and efficacy. The Federal Food, Drug and Cosmetic Act (the Act) recognises as official the remedies and standards in the Pharmacopoeia. The Federal Food and Drug Administration (FDA) has issued guidelines under which homoeopathic remedies may be marketed. The FDA guidelines permit a homoeopathic remedy, meeting the standards for strength, quality, and purity set forth in the Homeopathic Pharmacopoeia, to be marketed. With the exception of certain labelling and registration requirements not at issue, the FDA does not require homoeopathic remedies to satisfy other requirements of the Act. All of the homoeopathic remedies marketed by King Bio are listed in the Pharmacopoeia and comply with FDA guidelines.
Discussion (p. 4). At trial, NCAHF proceeded on the theory that there is no scientific basis for the advertised efficacy of King Bio's products. NCAHF performed no tests to determine the efficacy of King Bio's products and presented no anecdotal evidence but instead argued that King Bio's products were drugs, and that the scientific community required representations regarding the efficacy of drugs to be supported by acceptable scientific evidence. NCAHF asserted that the burden of proof should be shifted to King Bio to prove its products' efficacy. On appeal, NCAHF acknowledges that, under current California law, a false advertising plaintiff bears the burden of proving the defendant's advertising claim is false or misleading. NCAHF contends, however, that we should shift the burden of proof to the defendant to facilitate the campaign against health fraud. NCAHF argues that federal law shifts the burden to the defendant in false advertising actions.
We conclude there is no basis in California law to shift the burden of proof to a defendant in a representative false advertising and unlawful competition action. We conclude further that the legislature has indicated an intent to place the burden of proof on the plaintiff in such cases. Finally, we conclude Federal authority is not apposite.
Disposition (p. 22). The judgment is affirmed. National Council Against Health Fraud is to bear King Bic) Pharmaceuticals' and Frank J. King, Jr's costs on appeal.
The trial court concluded NCAHF failed to prove a false or misleading statement. King Bio's expert testified the products were safe and effective. The products were included in the Homeopathic Pharmacopoeia and complied with FDA guidelines. NCAHF presented no evidence that King Bio's products were not safe and effective, relying instead on a general attack on homoeopathy, made by witnesses who had no evidence of, or experience with, King Bio's products, and who were found to be biased and unworthy of credibility.
While it is not absolutely certain that a British court would come to the same conclusion, it would appear that the opponents of homoeopathy would be well advised to make a more thorough study of homoeopathy than they have to date. They would also be advised to study the court report of a recent civil action for "cruelty" by the RSPCA against a well-known homoeopathic veterinary surgeon, in which the RSPCA's experts were condemned in a manner similar to the NCAHF's experts in the Californian case. The case went unreported in the veterinary press. Whether this lack of reporting was or was not due to political factors is not known.
JOHN HOARE, BVSc, MRCVS, VetMFHom,
Mr. Hoare is mistaken as to the last point. The case referred to was indeed reported in the Veterinary Times, in fact it was an article discussing its continuing ramifications (top of the page) which started the whole thing. However, we still haven't heard any more about that matter, and it seems as if the case is still sub judice.
Regarding King Bio, it's difficult to see what Mr. Hoare's point is. He points out that the FDA guidelines relating to homoeopathic medicines in the USA do not require any proof of efficacy, and that responsibility for assessing efficacy for inclusion in the Pharmacopoeia is solely the provenance of "a group of homoeopathic practitioners". It is clear that the case was decided on a technical point, which was that a simple assertion of the fact that pure water is not medicine is insufficient under California law to substantiate an accusation of false advertising, without any actual test data on the particular water in question. Read someone else's opinion of this judgement here.
Who was it who remarked recently that the very worst place to settle a scientific dispute is in a court of law?
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