previous page of letters
The turn of the anti-homoeopathy league came round again in the 7th July issue, with a sequence of four letters each making different and very telling points.
[Volume 33, no. 25, 7th July 2003, pages 2-3.]
Homoeopathy - 1: having an open mind
Oh dear! I try. I really do try to have an open mind about homoeopathy. But when my friend John Hoare (23rd June issue) makes comments in my field of endeavour which are plain wrong, then I can no longer hold my peace.
As a dermatologist, I simply do not understand how anyone can state that the application of petroleum jelly to chapped skin is "homoeopathy in action". One could doubtless write an entire thesis on water and the canine skin, but, very briefly.
A water-impermeable barrier (such as Vaseline) when applied to the surface of the stratum corneum, inhibits the continuous, but insensible, passage of water, as a vapour, through the skin. This water passage is known as Trans-Epidermal Water Loss (TEWL). By inhibiting this loss, water is retained in the epidermis, the stratum corneum is rehydrated, the corneocytes swell, the tissue is thus no longer "dry" and the observed cracking is repaired. (There is much more to it than this, but it may suffice). The process has nothing to do with like healing like, nor dilutions to a millennial degree.
Equally, the injection of small quantities of allergens in an attempt to influence the immune system of an individual is not comparable to the many many-fold dilutions which homoeopathy uses. How then are the principles "very similar"? The former process relies upon some understanding of the physiology of allergy, the latter...
CHRISTOPHER CHESNEY, DVetMed, DVD, DipECVD, MRCVS,
[Volume 33, no. 25, 7th July 2003, page 3.]
2: Can we really take it seriously?
So homoeopathy may be explained by quantum mechanics? Are we supposed to take this seriously? Is there any way this can be taken seriously?
Mr Gregory (l6th June issue) declares that no amount of evidence will convince him that the "effects" of homoeopathy are a delusion. Well, at least he's honest about it, if somewhat fanciful in his search for a mode of action. However, he really must accept that it is possible for others to have investigated the subject very fully indeed, being quite open to any genuine evidence of a demonstrable, repeatable effect, and to have come to the conclusion that shaken-up water has no medicinal properties. Dismissing rational criticism as emotive, insulting and lacking in objectivity is not a reasonable argument and is not helpful. A truly open mind has to be open to the possibility that a pet theory, however beguiling, may be total nonsense.
The British Veterinary Voodoo Society (BVVS) is an international, rapidly-growing, serious organisation which provides a counter to the insinuation of magic into the practice of veterinary medicine. Our profession is science-based and should remain so. Interested persons should consult the BVVS website at www.vetlab.co.uk/voodoo/ for a detailed critique of magical methodology.
GEORGE W. TRIBE, BVM&S, MPhil, DLAS, CBiol, FlBiol, FRCVS,
[Volume 33, no. 25, 7th July 2003, pages 3-4.]
3: Rose-tinted view no longer tenable
There has been much recent correspondence in these pages concerning the dubious claims of homoeopathy, and we would like to add another strand to this tapestry.
We had previously adopted a "live and let live" attitude to alternative medicine practitioners, prepared to accept that although the objective evidence may be against them, their own clinical experience might lead them innocently to believe that they were creating therapeutic effects, but a number of recent instances have made this rose-tinted view untenable.
First, the preamble: we probably all accept that anecdote is one of the weakest classes of evidence in science, but this must be set against the classic Popperian view of science as that which is refutable. In this regard, a single anecdote as refutation may carry considerable weight, capable as it may be of striking at the foundations of a teetering pile of poorly-obtained, supposedly scientific evidence. So here goes.
Acute moist dermatitis is a common condition in our canine patients and, while we know that it may have many underlying causes and predispositions, acute treatment usually presents few problems. We are aware of a case, treated once before by a homoeopath, which followed a rather uneven course to recovery as the owner stopped and started the conventional treatment that had been given and patchily followed the homoeopath's advice at the same time. The owner was informed that she should not in future compromise treatment by the involvement of a homoeopath muddying the waters.
Some time later, the animal presented with a 5cm AMD lesion on top of its head. This time the owner went to one of the region's best-known homoeopaths and we have not treated the case, but we have had eye-witness reports of the animal's condition from a VN. After a week the condition had spread over its entire head and shoulders. None of the basic cleaning regime was done. Apparently this deterioration is all right because "it's the poisons leaving the system" and healing might take six months! As others may recall, homoeopaths often excuse deterioration after treatment in this manner. The homoeopath wanted to see the dog every two days, because he was "going to help them see it through". Apparently this never came about because the owners did not want to take the dog that frequently and so the case was managed over the phone.
Subsequently, the process spread along the dog's entire dorsum. The dog was reported to be depressed and sat rigid in an apparent effort to minimise the pain caused to it by movement. So much for the bleating from the homoeopaths about it being hard to conceive of harm being done by failure to access proper medicine. And was the homoeopath embarrassed by this case? No, he wasn't because it was all going according to plan.
Of course, it's an anecdote, but powerful evidence because it's presented against a background of standard knowledge about this problem and a routine expectation for simple recovery, so I think it is reasonable to draw the obvious conclusions. What happened ultimately? The condition eventually resolved, which meant that we chickened out of anonymously phoning the RSPCA. The homoeopath's defence would clearly be that the case behaved acceptably according to homoeopathic principles, but we would ask whether these principles should be given any weight by this profession.
Whereas one may wish to denigrate the owners involved as being fools that were soon parted from their money, this is to ignore the serious animal welfare issues and the fact that in taking their money the practitioner concerned was deluding himself and his clients. If, as a profession, we are supposed to act rationally in the interests of animal health and welfare, then surely these jokers should be removed from the pack.
One difficulty unfortunately we have is that so little of veterinary medicine is grounded on a fully double-blind trialled basis, so where can we draw the line that would include reasonable extrapolations of human medicine and the limited objective evidence that has been accumulated from our patient species, yet exclude the fantasies of the homoeopath? Perhaps we should take the holding of a homoeopathic "qualification" as prima facie evidence for expulsion from the RCVS: we think a strong case could be made that it brings the profession into disrepute!
In addition to these issues, we have also become somewhat tired of an implicit assumption that the alternative therapy MsRCVS have some monopoly on the touchy-feely parts of veterinary care. Those of us who treat animals rationally have just as much ability to empathise with both owner and patient. Yet in the public mind there now seems to be a largely positive attitude to these charlatans.
And finally, some other time let us tell you about the hyperthyroid cat that had been treated for over a year and made an appearance on Radio 4, for a homoeopath to claim success in its continued life, while showing off all of its classic clinical features of advanced hyperthyroidism. One of us contacted the homoeopath concerned with some specific questions about the case, but he found that he could not recall it well enough to answer, which is unfortunate.
Homoeopathy always works when black is white, and especially if one's memory shades out the awkward past. It has been suggested to me more than once that, if only we try homoeopathy, we would be convinced. Never mind the intellectual emptiness of such an appeal to yet more biased assessment, we see now how homoeopaths can be satisfied by their experience. When failure is claimed as success, then your personal anecdotes are pretty much guaranteed to be positive.
For too long, the profession has pussy-footed around this issue, possibly for fear of giving offence to well-meaning homoeopaths, but in our view, their ludicrous claims are in themselves offensive and need to be firmly refuted. We may have difficulty in having homoeopaths removed from the profession altogether, but surely any creeping acceptance of them by our governing bodies and professional societies must be prevented.
SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
[Volume 33, no. 25, 7th July 2003, page 4.]
4: Falling back on the scientific method
As a mere practitioner it would appear that I have not attained the degree of enlightenment that is required to fully comprehend the mystery of homoeopathy. I agree that, lacking this insight, neither objectivity nor a universal understanding are possible and I'm afraid I have to fall back on the scientific method where ideas have to be proved before they are accepted. This may seem very mundane and probably a product of the "small mind" to Mr Gregory (16th June issue) but it is tried and tested and it works.
This is the same scientific method that cures cancer and the bubonic plague, keeps aeroplanes flying and telephones working, heats our homes and cooks our food. After that, all that is required is an open mind and the ability to think critically. Using this method it is possible to look in detail at homoeopathy and all it implies and come to a conclusion that differs from that of Mr Gregory. My attitude is not that of one who hasn't researched the subject but is that of one who has researched it thoroughly and found it lacking.
At the risk of repeating myself, the endorsement of clever, even middle-class people does not validate anything. Sir Arthur Conan-Doyle, a respected and well-educated man, believed seriously, to his dying day, that fairies lived at the bottom of the garden; today, millions of people sincerely believe that metal spoons are bent by mind power rather than conjuring tricks. Both ideas are clearly ridiculous yet have large numbers of adherents who are happy to accept what they are told at face value. Similarly, good veterinary practice should be based on medical and scientific knowledge, not on dogma.
Mr Gregory is quite right to say that things such as vaccination policies and the use of commercially prepared diets should be questioned and kept under review. Why then does he feel uncomfortable when groups such as the veterinary task force question homoeopathy and present a different view to the one that he holds?
Without the scientific method, all we have is intuition and anecdote and if this is to be the basis for veterinary practice, what can we expect next? Faith healing or therapeutic touch: will we cure our patients by waving our hands over them? What about sending homoeopathic remedies by e-mail or telephone as suggested by Wayne Jonas, the USA's leading homoeopath and director of the American Centre of Alternative Medicine? What about psychic surgery: will we be dematerialising tumours out of affected animals? Why get upset at the mention of voodoo and other alternative practices when there is exactly the same amount and quality of evidence and exactly the same devotion from their followers as there is for homoeopathy?
As for the size of my mind, whilst it may not be large enough to meet the requirements of the Buddha, I believe that size isn't important: it's not what you've got, it's what you do with it that counts. This debate isn't about "viewpoints" or "politics" or "religion", it is about good medicine and animal welfare. At the end of the day, homoeopathic remedies are nothing more than water and the only thing water is good at curing is a thirst.
NIALL T. TAYLOR, BVM&S, MRCVS,
It was a fortnight before anything more appeared, but then.... The first letter is straightforward enough, but the second (from a VN rather than a vet) seems quite confused. Not only are we told that we must respect clients' beliefs, no matter how deluded, and of course that "allopathic" (does Miss Gower realise that this term is insulting?) vets also on occasion fail to cure patients, she seems at one point to be suggesting that one motive for opposing homoeopathy in the profession is to encourage clients to go (illegally) to lay homoeopaths, and so delay the seeking of veterinary care until the animal's condition is worse, thus ensuring greater income from the case. We think. If anyone has any idea at all what the last paragraph means, would they mind telling us?
[Volume 33, no. 27, 21st July 2003, page 2.]
The use of placebos?
With reference to the letter in the 16th June issue, I was amazed to see an admission that "no amount of placebo-controlled double-blind crossover trials" would convince Mr Gregory that homoeopathy has no other effect than that of a placebo. My own local GP uses homoeopathy but is sensible enough to admit that it is the only way he can use placebos in the UK without telling the patient (which would presumably spoil the effect). I think it is wrong to mislead the pet-owning public by stating that a medicine works unless you can back this up with some proof, not anecdote.
I think that most veterinary practitioners will admit to having treated hundreds of cats for cystitis with antibiotics. Nearly all of these cases will have apparently cleared up within a few days. Anecdotally this would imply that most of these cats had a bacterial infection. We now know that bacterial infection is not a common cause of cystitis in cats, and that a lot of these cases have sterile urine. Had these cats received no treatment (or a homoeopathic remedy) it is likely that the symptoms would have regressed naturally within a couple of days, but you would have been hard put to convince me that antibiotics were not necessary several years ago because of the apparent "treatment and effect". Get my drift?
I would suggest that Mr Gregory and his fellow homoeopaths read the chapter on the counting of chairs in a book entitled Snake Oil by the late John Diamond. In the meantime, of course, we will just have to take the homoeopaths' word for it that it works.
CHRIS FELLOWS, BVMS, CertVC, MRCVS,
[Volume 33, no. 27, 21st July 2003, page 2.]
Respect client beliefs
I have been following the debate on homoeopathy with interest. I will not pretend to understand or agree with all the argument either for or against. As a late entry into the profession as a VN, I will freely admit that some of the more scientific arguments have gone over my head. I will admit to feeling very strongly that any attempt to remove MFHoms from the RCVS will be bad for the profession. This profession is science-based, but it is also about customer care and no I do not believe "alternative therapy MsRCVS have a monopoly on the touch-feely parts of veterinary care" (Baker and Baker, 7th July).
To provide customer care you have to respect the client's beliefs no matter how misguided you may think they are. To me, a good vet will respect the client's wishes and guide them to the best solution for the animal.
In the last seven years I have worked in a variety of veterinary practices with numerous vets, six of whom were homoeopaths. Five of these used homoeopathy where and when they felt it was appropriate; it may have been the treatment they preferred but if the animal's condition indicated allopathic methods would be more appropriate, these would be used.
There seems to be some misconception that all MFHoms are by definition anti-vaccination. I have only found this to be the case in one of the six alternative vets I have worked with. The other five all advocate a common sense approach that appeals to the growing number of clients who are unhappy about yearly vaccinations without compromising the animal's ability to cope with exposure to the different pathogens.
In their letter of 7th July, Simon and Caroline Baker quoted a case where an animal's condition deteriorated to the point of causing suffering. May I suggest that this homoeopath's methods were not what I have come to expect from a homocopathic vet. I will not get into tit for tat and quote similar cases of bad veterinary practice by allopathic vets, as although easy to obtain it will achieve nothing.
It is true that aggravations are sometimes seen when a course of homoeopathy starts, the client is always advised of this possibility and advised to contact the vets in question, not so he or she can make more money but so they can review the case and make changes to the remedy or potency to keep discomfort to the minimum during treatment. What allopathic vet has not seen a case that has not responded to his first course of treatment, or "got worse before it got better"?
Earlier in my career I spent 15 years rehabilitating equines: it was during this time that in many cases the allopathic vets could not give me the help I needed so I looked for alternatives.
I freely admit that no amount of scientific evidence will tell me the results I got from alternative therapies was a figment of my imagination. Like many other people who do believe in alternatives, if I could not find a vet who respected my wish to use alternative where possible I would be inclined to self-medicate or use lay homoeopaths, legal or not.
This means potentially a vet may not see serious conditions until much later; this cannot be in the animals' best interest. It could be argued that it will be in the vets' as the sicker the animal the greater the potential to earn from it! Did someone say something about giving the profession a bad name?
I would like to ask the BVVS if any of them like playing with numbers? If you take the number of MFHoms I have worked with and assign it to the alphabet so A=6, B=12, C=18 etc., then the sum of the word vaccination =666.
TRACEY L. GOWER, VN, AICB,
Another week went by, a change of editor, and four more letters - a mixed bag this time. It's hard to resist the temptation to mock the homoeopaths' letters. Mr. Allport claims he's a lot safer when he's using placebos which can't cause adverse effects - maybe that's quite true! Miss Hehlmann reprises practically everything already said on her side of the subject, including the "small-minded" point, then comments that the argument is going round in circles. She's also very concerned about chemicals and toxins and pollution. However, even if she herself is (as she seems to imply) an overweight, Big Brother-addicted couch potato, we would only plead with her not to assume that all her colleagues are in the same category! Once again we admire Mr. Plenderleith's contribution. Brevity is in very truth the soul of wit.
[Volume 33, no. 28, 28th July 2003, page 3.]
Successful 'magic' of homoeopathy
The recent vitriolic attacks on homoeopathy by Morag Kerr in this and other magazines [this refers to a letter in Veterinary Review where there was also a short homoeopathy thread], and the anti homoeopathy "anecdotes" described by Caroline and Simon Baker (7th July issue) have prompted me to review my therapeutic treatment of my patients. I graduated 30 years ago and have spent 10 years using purely "conventional" therapies, 10 years using conventional and "natural" therapies (especially homoeopathy), and for the last 10 years referral work in natural therapies only.
Why did I change from the drug therapy I had been taught was the only way to treat patients, to what I do now? Certainly not for profit. As I no longer administer vaccines, prescribe drugs or perform expensive operations, my income is less than as a conventional vet. It is simply that I found homoeopathy and other therapies such as acupuncture and phytotherapy to be effective and less likely to cause adverse effects.
I regard myself as a reasonably rational being, and I do not feel I am deluding myself when I see the results of my present methods of treatment. Of course, not all my patients benefit from miraculous cures, but a large majority appear to show a positive response to treatment. Surely these cannot always be spontaneous resolutions?
I am sure I have made mistakes in the past, both in my previous conventional existence, and now in my present holistic incarnation. But any mistakes I may make now will be less dangerous for the patient.
Caroline and Simon Baker are correct in their implication that using homoeopathy can result in harm. Misusing any therapy, or using any therapy inappropriately, can be harmful. However, I feel it is unlikely any homoeopathic remedy could cause an adverse effect such as was suffered by a feline patient of mine who became blind after a single injection of a particular pharmaceutical product given by the referring practice.
I was going to refute the claim by Morag Kerr that homoeopathy is magic, but a referral letter from a veterinary colleague has just reached me. She has referred a third patient with an intractable alopecia, following remarkable success with the first two. "I hope you can work your magic with this patient too," she comments. So homoeopathy is magic after all. Well, if it is, it's bloody good magic and I shall continue using it.
RICHARD ALLPORT, BVetMed, VetMFHom, MRCVS,
[Volume 33, no. 28, 28th July 2003, page 3.]
'Guilty until proven innocent'
I read with interest John Hoare's letter of 30th June reporting acquittal of charges of false advertising of an American supplier of homoeopathic remedies. He invites us to draw the conclusion that the absence of evidence of inefficacy of a treatment should be equated to evidence of efficacy. A few moments with a pen and a Venn diagram would clearly be in order here to see how wrong this is!
This irrational proposition arises from taking, without thought, the burden of proof (innocent unless proven guilty) from the criminal code into the realm of medical regulation. Society has determined that the morally-correct criminal burden should be designed to protect the innocent from wrong verdicts, but as a matter of simple logic we know that under this principle, those truly guilty may also be "let off". Thus, the acquitted will include both the truly innocent and the guilty but incompetently prosecuted.
In drug regulation we want to "acquit", and therefore license, only the genuinely innocent (safe and efficacious) drugs, so the proper principle should be "guilty unless proven innocent, but subject to revision back to guilty should new evidence come to light" - a little unwieldy, but accurate nonetheless. OK, put your pens down now.
Let us suppose that quack remedies were placed under the same obligations as conventional medicine to demonstrate efficacy, and that a case was then brought under the drug laws instead of trades description laws over selling a product in the absence of such evidence. Let us take a minute to consider the likely outcome... Did you need the whole minute? Nor did I.
We should therefore thank Mr Hoare for very well demonstrating the case for addressing the anomalous status of homoeopathic treatments by making them conform to the same demands for safety and efficacy that apply to the rest of our pharmacy. The self-evident vacuity of the arguments made in defence of homoeopathy, of course, only serves to strengthen the case against it. I would like to thank Morag Kerr and George Tribe for establishing www.vetlab.co.uk/voodoo/, where other examples of magical reasoning can be reviewed.
SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
[Volume 33, no. 28, 28th July 2003, pages 3-4.]
We are just going round in circles...
With increasing disbelief and sadness I have been following the recent discussions. So now is the time to blame the homoeopathic vet from Hertfordshire for not being able to treat skin conditions or hyperthyroidism?
Mr Hoare does not understand the anatomy and physiology of skin (sorry, does this lack of knowledge in one particular field of medicine have to lead me to the conclusion that homoeopathy does not work?); and just a few weeks ago one of our fellow Australian vets educated us about the malpractice in conventional medicine, so who is worse? I cannot really work out what the problem is with therapies that are not as explicable as the scientific conventional therapy seems to be. I can only see that there can be true bad practice of any kind.
Having been involved in acupuncture for several years, most of my lecturers do acupuncture, homoeopathy and herbal medicine and treat many chronic conditions after they have been thoroughly investigated (and unsuccessfully treated) by their conventional counterparts, often being referral cases. I always admired their dedication, knowledge, insight and true interest in their patients combined with great enthusiasm and psychological skills to find out what is wrong.
Contrary to that, I have to say that I have seen quite a number of conventional doctors/vets who did not seem to have had any interest in the pet/patient at all, waved a few drugs about and sent the patient home after about five minutes at most, until the next problem arose or that one was not cured. Why do so many of us find it so hard to accept that others can possibly do a good job with ideas that have never crossed our minds or that we cannot grasp? Is it the petty human mind that wants to stick to what it has learned forever and shut its eyes to everything else that might challenge our hard-earned knowledge? And might it creep up secretly that a part of this hard-earned knowledge may not be true or sufficient? And then we have to deny even harder that there might be something more than science?
I think everybody has a right to practise whatever method he or she feels best about as long as he or she does a good job and spends enough time to thoroughly learn and research what he or she is doing. No doubt there are as many black sheep in the complementary field as in the conventional.
Rather than denying/criticising and putting down other ideas of medicine, we should all move forward and recall that our aim as professionals should be to promote health and well-being.
Maybe one could, for example, challenge clients by asking them if they actually know what atopy is or what the word allergen means? Could it have to do with so many of us not caring/ignoring the basics as too crude and simple, e.g. is it difficult to ask not to use chemicals if avoidable, not to drive if we can avoid it, to walk more (overweight us and overweight dog)?
Does the scientific mind honestly believe that drugs alone (well-researched, of course) are really enough to battle against allergies, asthma, obesity and the lot? How could one drug or 10 drugs, however well-studied, counteract all these influences from the outside, the increasing pollution that throws out more and more toxic substances, the obesity being caused by not getting our backsides off the settee because we would rather watch Big Brother? Do not many complementary medicines have their base in looking at these very basics and try to challenge their making the patient aware that there is more to health than just throwing down some pills?
Oh dear, do I sense a worship kind of drug cult? Could we do a bit of work together to get the sciences off their throne? Drugs certainly do a lot of good, but can cause much damage too. They can have the power to kill as well as to cure. How come that in spite of all these scientific double-blind studies that prove that drugs are effective and help everyone, Britain is now scared that by 2020 half of our population and, presumably, half of our vet patients might be overweight?
Could I guess that well-applied homoeopathy in an in-depth consultation to investigate the problems of the patients could have saved a few of the 2,000 deaths a year claimed in GB by misuse of paracetamol? Or saved some thousand patients of these 125,000 in the USA that die each year from side-effects of prescribed drugs. Yes, they did not die from homoeopathic treatment! What about all these women who had HRT for many years prescribed by their well-meaning GP after having read the double-blind studies done by the pharmaceutical industry to prove that this is the name of the game to fight osteoporosis?
How many of them have an increased risk of breast cancer/ thrombosis now, so big a problem that a study in the USA conducted to investigate its full benefits had to be called to a halt because it was too dangerous to continue?
Surely, a great deal cures itself (remember those cats with the horrible abscess, you prescribe a week of antibioitics only to meet the owner a few weeks later telling you that he only got two of them in but that the cat is fine now?). So if you give some good back-up with whatever method, is the homoeopathic approach any worse than the other?
The mind plays a very important role for the owner/patient, so if he trusts you with whatever method you are using you have a good chance of doing well. I do hope that any responsible homoeopathic vet who works as a GP does not leave the Solu-Medrone in the cupboard when seeing an RTA.
I have not the slightest objection to conventional drugs as such, of them being necessary on many occasions, and certainly many of the human and animal species would not be alive without the sensible use of them. To conclude, I feel that we are just going round in circles here, and although a debate should be stimulating and provoke thought, I cannot really see the use of trying to get homoeopathy off the list of available treatments. Speak out if you see some true quackery in any discipline, and otherwise strive to give your best with whatever approach!
ANDREA HEHLMANN, DrMedVet, DipHumAcup, MRCVS,
[Volume 33, no. 28, 28th July 2003, page 3.]
Can we justify the unjustifiable?
Predictably we have had to suffer reams of nonsense from Messrs Hoare and Gregory trying to justify the unjustifiable. Is it "me thinks they do protest too much", or is it "full of sound and fury signifying nothing"?
I am not clear if they are promulgating Buddhism or Hahnemannism, but frankly I think they are really followers of Kant. Kant prove a thing even after 200 plus years!
Personally I am an NIMP. Not In My Profession.
ROBERT W. PLENDERLEITH, BVMS, MRCVS,
The following week - I thought we weren't supposed to talk about this?
[Volume 33, no. 29, 4th August 2003, pages 2-3.]
John Hoare (30th June issue) appears to criticise the RSPCA, which he assumes to be opposed to homoeopathy. It is, of course, not. Mr Hoare seems to base his conclusion solely on the observation of the outcome of what he incorrectly calls a civil action for cruelty against a well-known homoeopathic veterinary surgeon. Of these proceedings Mr Hoare says the RSPCA's experts were condemned in a manner similar to the NCAHF's experts. According to Mr Hoare, the NCAHF failed to prove a false or misleading statement, 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.
By inference, Mr Hoare levels similar accusations against the Society. It is clear that Mr Hoare is not aware of the details of the case, otherwise he would not make such unfounded allegations.
The case brought by the Society was in relation to an offence under Section I of the Protection of Animals Act 1911. This is, of course, a criminal offence and not a matter dealt with by the civil courts. The case concerned a dog with such severe trauma that one veterinary surgeon described it as having half its face missing.
The Society alleged the dog had been caused unnecessary suffering as a result of an unreasonable omission in the treatment of the dog based on the following: a failure to adequately diagnose the condition; a failure to refer the matter when it was clear that treatment was ineffective; a failure to keep adequate clinical records; a failure to provide clinical records when the matter was referred for a second opinion; a failure to provide adequate anaesthesia; a failure to take into account the future need for skin grafting and attendant traumas; a failure to give appropriate consideration to euthanasia and to appraise the owner/client of all options and consequences.
These were omissions that we believed were made regardless of whether the dog was treated conventionally or not.
The District Judge said in his written decision on the case: "... it was more than once made clear by the prosecution that the case was not a contest between the principles of conventional veterinary practice and homoeopathic veterinary practice. Indeed it was said in terms that this was not a case about the rights and wrongs of homoeopathic treatment."
The dog was seen by four veterinary surgeons, two in clinical practice and two specialist consultants. The District Judge said of these witnesses that he believed they had "given [him] utterly truthful evidence". Of one of the experts, the District Judge concluded he was probably the leading veterinary dermatologist in the country. To suggest any of the veterinary surgeons who gave evidence for the prosecution were biased and unworthy of credibility is frankly disingenuous.
The fact that the Society instigated proceedings against a veterinary surgeon who just happened to treat the dog homoeopathically should not be interpreted as an opposition by the Society to homoeopathy. The use of homoeopathy has its place and it is a discipline recognised by the Royal College. Interestingly, the Royal College applies the same standard of professional conduct to a veterinary surgeon who practises homoeopathy as it does to one who practises conventional veterinary medicine.
The concerns the Society had over the management of this dog may not have resulted in a conviction, but I understand the matter is currently under consideration by the Royal College.
Once again we encounter the misconception that homoeopathy is an RCVS Recognised Speciality - a misconception which is frequently encouraged by the homoeopaths, and which was specifically traded on in the case under discussion by presenting the list of "Homoeopaths" in the Register in a misleading context. The difficulty is clear. However much the RSPCA might disapprove of an animal being treated for serious disease by shaken-up water, how can they criticise this practice if they sincerely believe that the RCVS approves?
Oh, and it's Mr. Gregory again. Need we say more? We too are riddled with 'misconceptions', and no matter how well informed about the subject we become, we'll never be free of these unless we agree with him unreservedly. Interestingly enough, this letter was followed by the comment, "The editor reserves the right to shorten letters for publication." Mere coincidence of layout, we're sure.
[Volume 33, no. 29, 4th August 2003, pages 3-4.]
A valuable tool...
May I correct some of the misconceptions which your correspondents have chosen to make following my letter of 16th June.
Science is defined by the Concise Oxford Dictionary as "knowledge". A generally accepted, broader definition is the "pursuit of knowledge". The "scientific method" is the triad of observation, hypothesis and experiment which serves to add to the body of knowledge. We can safely assume that it was this method which primitive man employed when rubbing two sticks together to make fire. It is uncertain how many placebo-controlled randomised trials were performed before the principle was generally accepted.
The use of the scientific method was precisely how homoeopathy was developed. As evidenced by his notebooks, Hahnemann's experiments were meticulous. In the clinical trials he conducted, i.e. by using homoeopathic medicines, he observed that material doses of medicine administered on homoeopathic principles caused an initial aggravation before the curative effect set in, and it was to minimise this that he experimented with diluted medicines.
By experimentation, Hahnemann found that simple dilution attenuated the medicinal effect, but that if the solution was subjected to vigorous shaking ("succussion") the medicine actually became more powerful, hence the description "potentised medicine". In addition, he found that the troublesome initial aggravations were markedly reduced. These observations have been corroborated by practising homoeopaths ever since. My own observations have confirmed to my satisfaction that potentised. medicines, when correctly prescribed, are capable of inducing profound healing processes. I have occasionally witnessed the aforementioned aggravations, the management of which requires an understanding of homoeopathy and of how an organism reacts to disease and to potentised medicines.
As a scientist I have confidence in my own powers of observation. Dr Kerr and Mr Tribe conveniently omit the words "which I observe daily in my practice" in their reply to my letter, for obvious reasons.
With reference to Mr Fellows' misquotation of my letter, Churchill Livingstone's International Dictionary of Homeopathy defines a placebo as (1) "a substance with no biological properties given to satisfy a patient's expectations of treatment", or (2) "an inactive agent used for comparison with the substance or method to be tested in a controlled trial, and indistinguishable from it". In humans, the placebo effect has been ascribed as responsible for up to 30% of the improvements observed in patients in any clinical trial. This is independent of the form of the medicine tested.
Whether the placebo effect occurs in animals has not to my knowledge been tested, perhaps for ethical reasons, but my observations in general practice, long before I encountered homoeopathy, led me to believe that it is a phenomenon which can be observed in animals, and certainly in their owners. It is my contention that a caring attitude and a positive approach can influence the outcome of any veterinary intervention beneficially.
Trials in humans have demonstrated that potentised medicines have effects significantly greater than can be explained by placebo effect alone. However, it is interesting to examine in these trials how powerful the placebo effect can be, both positively and negatively, on a patient's health.
The placebo effect in humans is a powerful tool, and many medical doctors do their best to harness it to the benefit of their patients. Research has also suggested that the effect of homoeopathic medicines is enhanced by the hour-long consultations which are necessary for the homoeopathic treatment of chronic disease. This would almost certainly apply to western drug medicine as well, were it to be employed, but I am unaware of any research to corroborate this. I can only guess that this is the sort of "magic" which Dr Kerr wishes to see prevented from being "insinuated" into veterinary medicine.
Compassion (the "touch-feely bits") is certainly not the monopoly of those who of us who practise alternative therapies; however, if it is the perception of the public then it would be logical to look into the reasons for this; they are not difficult to find. But that is another story.
Western drug medicine, homoeopathy, traditional Chinese medicine, and the various forms of indigenous herbal medicine traditions found globally are all belief systems. They each have their own scientific background.
Western drug medicine takes as its gold standard the placebo controlled random crossover trial. Very few of the interventions within this belief system are supported by such evidence, and in view of recent advances in physics the usefulness of this model is increasingly in doubt. It seems unlikdy that this method is suitable for the examination of other belief systems; clinical audit may be a more suitable approach.
Considering the resources attributed to it, Western medicine has so far been notably unsuccessful at curing cancer, or even the common cold. It has no real answer for viral disease. Bubonic plague disappeared of its own accord, and it was serendipity and the ability of one man to look beyond the obvious that brought us the miracle of penicillin. Almost all the drugs used by Western medicine have toxic side-effects of some kind.
As far as I am aware, the Veterinary Surgeons Act does nor limit veterinary surgeons to one therapeutic modality alone, and those of us who wish to develop other forms of medicine are free to do so. Having never read the Act, I am open to correction on this.
The clinical observations of homoeopaths the world over convince us that we are in possession of a valuable tool for relieving the suffering of our patients, and I repeat my warning that it is essential that the veterinary profession provides this service. The General Medical Council has directed all undergraduate courses in medicine to provide tuition in homoeopathy; our profession can follow this lead, or it can bury its head in the sand and see our potential patients drifting off to unqualified therapists, with the inevitable consequences.
Sadly for our profession, and for its standing with our clientele, this debate will be on-going and the present flurry of correspondence is only surprising in its unseemliness, but when your correspondents finally dispense with the emotive language which typifies their opposition to homoeopathy, and confine their arguments to the rational and the scientific, the more likely will I be to believe that the issue is not one of belief systems, and the more likely will I, and I suspect the majority of the veterinary profession, be to take them seriously.
In conclusion, it appears that the subtleties of the Buddha's teaching has been lost on your correspondents, and the meaning of the phrase "fully investigated" misunderstood.
Maybe a more direct quotation, from the physicist Niels Bohr, is more appropriate: "Those who are not shocked when they first come across quantum theory cannot possibly have understood it." Perhaps the same can be said of homoeopathy.
PETER GREGORY, BVSc, VetMFHom, MRCVS,
We don't think that in the mid-1960s, when much of the legislation affecting the profession was drafted and homoeopathy was generally perceived as being in terminal decline, it even occurred to anyone that veterinary surgeons would continue in any numbers to renounce their rational scientific training and espouse 19th century pseudoscience. The popularity of 'New-Agery' has a lot to answer for. Well, the VSA is about to be revisited. Is this one point we should perhaps be thinking about? We don't know how true it is that the GMC has insisted that medical students should be taught to treat their patients with shaken-up water. Perhaps just as true as the bit about homoeopathy being an RCVS Recognised Speciality?
It seems likely that by "fully investigated", Mr. Gregory means actually treating one's own patients homoeopathically. Can he not understand that no ethical veterinary surgeon is likely to experiment on his patients by treating them with shaken-up water (unlicensed) instead of legitimate licensed therapeutics?
The next week two more correspondents who featured in the ten-year-old Veterinary Record homoeopathy thread made a reappearance. It's so nice to know that Mr. Hunter doesn't disapprove of those of us who practise what we were taught in College! However, it is Mr. Jessop's contribution which is particulary noteworthy.
[Volume 33, no. 30, 11th August 2003, page 2.]
Facts on homoeopathy
Homoeopathy: what is the fuss all about? Let us establish some facts.
I suppose it is possible that all these intelligent and diligent researchers and practitioners around the world are misguided and wrong, and that a small number of rather insular and scientifically, but narrow-minded veterinary surgeons working in practice and laboratories are right. I rather doubt it.
I have been qualified for 50 years and hopefully one thing you learn is to be tolerant of others and their views. For nearly all the time I have been in mixed general practice treating all kinds of different species and animals.
I was introduced to homoeopathy by a doctor friend in 1980 and to acupuncture in 1985. Until I retired from the partnership in 1995, I happily combined homoeopathy and acupuncture with conventional medicine, using whichever type of treatment, in my opinion, best suited the case.
Since 1995 I have run a referral service in both disciplines and no longer use allopathic treatment. The referrals are nearly all initiated by the owner and come with the knowledge, if not always the blessing, of the client's own veterinary surgeon.
Most of the cases that I see are not responding to conventional medicine, are suffering from side-effects, or are cases for which conventional therapies do not exist and therefore have nothing to offer. The feedback on most cases, but certainly not all (which goes for ordinary medicine too), is positive and I believe I am helping animals that are ill or suffering in some way.
I am in no way decrying conventional treatment and would not hesitate to recommend it if I thought it was appropriate and was necessary to alleviate pain or suffering.
My plea is that there is room for all of us. Can we not be "grown-up" and "joined-up" like our Government and agree to disagree? At the present time our profession needs all the support it can get, and surely we should all be standing together rather than bickering about treatments that will either stand or fall depending on how successful they are.
FRANCIS HUNTER, MRCVS, VetMFHom,
[Volume 33, no. 30, 11th August 2003, page 2.]
Don't believe a word...
I was going to watch this debate with bemused silence and leave it to a new group of combatants; however, a letter from Richard Allport (28th July issue) forces me to write.
When I first qualified, a small section of clients were dabbling with homoeopathy. Due to a desire to understand the system, I signed up to three of the four modules at the Royal Homoeopathic Hospital in London. I tested this mode of therapy on clients and saw the occasional referral. I spent 18 months working as an assistant for Richard Allport, covering the conventional wing of the practice and seeing the homoeopathics when he was away on leave. I joined the British Veterinary Homoeopathic Association and attended many of the meetings. So what did I learn?
I can only say I don't believe a word of the mantra. I think as a method for delivering placebo, it is excellent. I find the placebo effect very strong in our patients (or rather the client). I feel that credible evidence cannot, nor ever will be, produced for homoeopathy. I for one feel that listing of the VetMFHom by the RCVS was a sad mistake.
MIKE JESSOP, BVetMed, MRCVS,
We're not entirely sure what Dr. Baker was on when he wrote the following, or whether it was entirely legal. We note at any rate that Mrs. Baker chose not to associate herself with this missive! However, we don't blame him. The whole concept is so overwhelmingly ridiculous that there comes a point where you just have to laugh.
[Volume 33, no. 30, 11th August 2003, pages 2-3.]
Veterinary Times readers lead such busy lives that doubtless few have heard of J. K. Rowling or her creation, Harry Potter. But for those who have, I thought a consideration of the role of magic in her world might bring light to some of the interesting concepts that have been touched upon when discussing the claims of homoeopathy. Some familiarity with the books is required; everyone else should pass on down to the letter abusing the idiots of the Competition Commission, because no week should go by without Veterinary Times publishing at least one.
Meanwhile, those still with me may have noted that J. K. Rowling's books contain a highly rational view of magic, which the homoeopaths should attend to. Magic is an accepted fact in her world. There is no explanation of how it works (none is required), but there is an acceptance that it works. The effects are usually so dramatic that no trial beyond n = 1 is needed.
Individual anecdotal accounts would be so improbably caused by chance that they must betray a real effect in operation. Thus, a hedgehog is transformed into a pin-cushion. Assume no cheating. If this was done behind closed doors and then an impartial judge was allowed to enter, then that judge would have no difficulty in spotting the transformed object and the real efficacy of magic would be proven. So, in general we would accept that magic is real if we lived in JKR's world.
But in her world, not all magic is real. Here's another situation. Divination teacher makes the statement, "That thing you are dreading, it will happen on 16th October." On 16th October, Lavender Brown receives notification of death of her rabbit and is convinced the prophecy was true by ignoring the fact that the death had not occurred on that day and that the death was only being "dreaded" in retrospect. The point of this is that the conditional probabilities of retrospective analyses are impossible to define; only prospective trials count.
The homoeopath's description of fitting the post hoc justification of whatever the remedy has or has not done represents the first kind of analysis. Very rarely Professor Trelawney makes a genuinely scary prospective prediction that is true. How do we know that it is a truthful prediction? Is this not another anecdote that could be ascribed to chance? The possibility cannot be excluded, but the intrinsic unlikeliness of the predicted event makes any imputed probability for its occurrence vanishingly small, so the extraordinary claim is likely to have been a true prediction rather than a lucky guess.
Contrast this with homoeopathy: the intrinsic probabilities of coincidence in the claimed effects are high, while the supposed beneficial effects are allegedly seen time and time again.
The intrinsically high probability of coincidence is why anecdote is worthless and the sheer number of claims allows statistical analysis to be brought to bear so anecdote is irrelevant.
So ask, would Harry take the Skelegrow or a homoeopathic remedy instead? I think he'd take the Skelegrow.
Why put the argument like this? If even fictional magic can be seen to be capable of rational analysis, how much more so can the claims of homoeopathy be subjected to the same rigours? So, the frequently-heard objections of the homoeopaths to the principles of scientific testing are defeated, yet again.
Now, in the words of Argus Filch, "Nighty night."
SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
Yes, we wonder with Mr. Plenderleith whether the Competition Commission ever did get round to commenting on the monopoly situation and rising price of diluted water.... Simon's point is actually perfectly clear. If homoeopathy were self-evidently efficiatious, we wouldn't be having this argument.
The following week's correspondents couldn't possibly have read the Harry Potter analogy, but they still seemed quite put out by the "spite" of the scientific lobby. We feel no spite, and we see none - just rational argument being met by dogmatic assertions and irrational belief-systems. However, if just one more magician tries to psychoanalyse us, or exhorts us to keep an 'open mind' about this discredited nonsense, we might not be responsible for our actions....
[Volume 33, no. 32, 18th August 2003, page 2.]
Recently these pages have been devoted to a great deal of bickering - one could hardly refer to it as debate - on the subject of homoeopathy versus conventional medicine.
Many of the contributors have made reference to homoeopathy as being an "alternative" treatment, but I proffer the word "complementary" as a more descriptive term.
I would urge all your readers to study two books. Firstly The Organon, by Samuel Hahnemann, the father of homoeopathy's treatise on the practice of medicine (anti-homoeopaths should note it preceded the birth of homoeopathy). Hahnernann lived in a time of "modern medicine". In his day the conventionalists favoured blood-letting as the modern medical approach: Many, including George Washington and Goethe, fell at the hands of phlebotomists.
The second of my recommended books is Wild Health, by Cindy Engel, in which the author describes, backed by a multitude of references, the ability of animals to treat themselves when sick, and to repair themselves and others when injured.
My belief is that the homoeopath who fails to see the need for surgery is just as useless to his patient as the conventionalist who forgets that nature is the great healer. "They get better despite what we do to them" is as true now as it ever was.
"Complementary" is what we should be. I considered the reason for such violent outbursts by some of our members, and no doubt there will be more. I came to the conclusion that the driving force is fear. I am reminded of the first line of a Lighthouse Family song: "Sometimes I get tired of this 'me first' attitude."
For all those who believe "competition" is a healthy way forward in this profession, I put it to you that "co-operation" is what we should be striving for. Competition will harm our patients; co-operation can only be of benefit.
Jews, writers, thinkers, medics, gays, men, women and children have all at some point in history been persecuted by narrow minds. To date, so far as I'm aware, vets have not been. Let's keep it that way.
And finally, while the bickering was going on, who noticed Mars International's plan to spend £400 million on 10 UK "pet resorts" incorporating Banfield Veterinary Clinics? Is that competition? It doesn't seem like co-operation from a company that has grown out of our recommendation of its products.
PETER A. CULPIN, BSc, MA, VetMB, MRCVS,
There's just one question here. Who or what is the "Lighthouse Family"? Oh, and a comment. We thought the fact that many patients have the capacity to get better if you simply leave them alone was the point that we were trying to make!
[Volume 33, no. 31, 18th August 2003, page 2.]
Poor quality of debate
During the last two weeks I perused some copies of Veterinary Times as well as Veterinary Review (July 2003). I was shocked and dismayed to read some of the letters from your correspondents on the topic of homoeopathic practice.
The poor quality of debate, petty and spiteful attacks on those who choose to use this for the benefit of animals is extremely disappointing and not at all what I would have expected from this profession. The concept of a "Veterinary Voodoo Society" for the benefit of discrediting homoeopathy is beyond belief at a time when there are so many important issues to address. What on earth is going on?
Can the profession afford to support the inflated egos and dictatorial manner of some of its members who mistakenly believe they have reached a God-like state and the limit of all learning? To some of these folks it seems a source of great irritation when other methods appear to work and the confounded animals get better when they clearly should not.
I am a registered homoeopath. It took over four years to study for the qualification and I would urge any member of the veterinary profession to maintain an open mind and learn more about it. Those who use it will provide you with a lot of evidence and if you care about developing your practice, you are likely to recognise how homoeopathy can, and often does, complement conventional treatment.
SARAH HAMILTON, MA, BA, LCHom, MHMA,
A week later we finally got round to raising the question of Mr. James Randall's Million Dollar Challenge. However, we still have a couple more pro-homoeopathy contributions to wade through first.
[Volume 33, no. 32, 25th August 2003, page 2.]
Calm and rational discussion necessary
It seems that I was misinformed about the details of a recent "cruelty case". I apologise to Mr Rogers and the RSPCA for any perceived slur on their good name. I am pleased to note, however, that they have no objection to the practice of homoeopathy by veterinary surgeons.
The point that I was trying to make is that while the principles of homoeopathy are difficult for some people to accept, criticism must be based on an understanding of the theory and philosophy of the therapy, and not on the principle of, "I do not think that it could work, therefore it doesn't work, therefore I will never use it and nor should anyone else".
Similarly the use of such emotive terms as "quackery" do nothing to aid a sensible and serious discussion of the topic, and people who do use them ought to be able to defend their use of those terms.
Returning once more to the subject of proving that homoeopathy is an effective mode of treatment, much is made of the random controlled trial (RCT) and it is often referred to as the "gold standard" for proving the efficiency of medicines.
It should be remembered that a gold standard is only good for the material that it is designed to measure. Thus silver and platinum cannot be measured against a gold standard. Similarly, while the RCT is the "gold standard" for evaluating pharmaceuticals, it is only suitable for use in cases where all patients are assumed to have identical physiological and psychological characteristics. Since homoeopathy and other complementary therapies insist that all patients are individuals, and attempt to treat them as such, the RCT becomes inapplicable.
It should also be noted that RCTs are not used in other branches of the medical art such as surgery and psychiatry. Clinical outcome surveys and patient benefit reviews may well become the preferred tool for assessing complementary therapies. It would be nice, however, if the discussion could be held in a calm, rational manner, rather than the highly-charged atmosphere that is so easily generated when this topic comes up for discussion.
JOHN HOARE, BVSc, MRCVS, VetMFHom,
Mr. Hoare doesn't seem to have realised that the randomised double-blind placebo-controlled trial (RDBPCT for short) isn't by any means the "gold standard" test to be applied to every therapeutic intervention. It's quite pointless and indeed highly unethical to go through such an exercise for a self-evidently efficacious treatment. Imagine such a trial of insulin, for example! None has ever been done, nor will it be - and for exactly the same reasons, it will not be done on any insulin-substitute which might be discovered in future. No RDBPCT was done on trilostane, yet it was very quickly licensed. In fact the RDBPCT is the final arbiter of the NOT self-evident effect, where there is real doubt whether there is anything there at all. Unfortunately, nearly all "alternative" medicine is in that category, and certainly all of homoeopathy - if it were not, it wouldn't be "alternative", let's face it. There should be no difficulty doing such trials even on "individualised" homoeopathy, all you have to do is treat all the patients exactly as they would have been anyway, but only dispense the real shaken-up water to a random half, the other half get ordinary water. Of course trials like this are being done (for example White et al., 2003), but the chances of that finding its way into Mr. Hoare's reference list are fairly remote.
But we forgot. It works!
[Volume 33, no. 32, 25th August 2003, page 2.]
Complementary healing 'works well'
I am responding to the letter by Mike Jessop (11th August issue). I find his feelings towards homoeopathy very sad, as for the last five years I have been forced to concede that complementary healing in its broadest sense works very well indeed.
Of course no one therapy has the entire answer, for it is very obvious that not even allopathic medicine can cure everything. Each can and does complement the other. Coincidence may be the explanation for one or two cures, but when it is repeated over and over again then such an easy explanation cannot be ignored.
All therapies aim to produce ease from dis-ease [sic]. Allopathic medicine uses pure substances. Herbal medicine uses many of the same substances in their natural state. Homoeopathy uses the energy from these plants and substances as healing techniques utilise the energy in the world around us to achieve the same result. All essay to allow the free flow of energy around the body. Acupuncture also endeavours to do the same thing by unblocking the meridian energy cannels.
These are all doors into the same room. To credit one technique to the discredit of the others is wrong. Each system has its strengths and its weaknesses. Each should not be used in isolation.
Allopathic medicine is not perfect, but with help from these other disciplines an ecumenical agreement would benefit ourselves and our patients.
CHRISTOPHER KENYON, BVetMed, MRCVS,
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