previous page of letters
Hmmm, judging by the tone of the next batch of letters, it looks as if not only do the homoeopaths not want the money, they aren't interested in the publicity value or the objective vindication that would accompany success in the Challenge either. Oh well, we can't say we're terribly surprised.
The letters simply rehash points already made and already pretty comprehensively demolished, so we can't see much point in going over it all again. However, there are a few interesting details - for example, who or what are the "Stereophonics", who is Mendeleyev [oh, the chap who devised the periodic table!], and while we're at it, in what way does homoeopathy, invented by a German physician, not qualify as "Western" medicine? Perhaps we should be told!
[Volume 33, no. 44, 17th November 2003, pages 22-23.]
Illogical core belief about homoeopathy
As the Stereophonics have enquired: Is anyone going anywhere?
QED: in the final analysis, if it could be demonstrated that homoeopathic medicines possess properties which water or alcohol do not possess, Dr Kerr would be convinced of the efficacy of homoeopathy as a therapy. This is not logical, but Dr Kerr is not alone in thinking thus; the vast majority of the opponents of homoeopathy hold this core belief, namely that potentised solutions are physically, chemically and pharmacologically inert.
To maintain this belief it is necessary to: (a) ignore the evidence of literally hundreds of trials which suggest the opposite, from the effect on the growth of wheat seedlings to that on the post partum calving interval in dairy cows; (b) reject the advances in physics which have occurred over the last 80 years; (c) deny the powers of observation of millions of patients, doctors, animal owners and vets.
The corollary to this is that any veterinary surgeon who claims homoeopathy has any merit is either deluded or dishonest.
The latter, one assumes, is the reason that it becomes acceptable to vilify the members of one's own profession in the way so apparent in the correspondence in these pages over these last few months. I would, incidentally, suggest that the definition of a profession should contain some reference to treating one's colleagues with respect, and I suspect that what is increasingly seen by many as an unprofessional squabble has done more damage to the reputation of the veterinary profession as a whole than some of your correspondents realise. I for one shall not be contributing to the present discussion any further, for this reason.
Those who practise homoeopathy start from the opposite position. As Audubon; the great American ornithologist and artist, said, "When the bird and the book disagree, always believe the bird." In this case the bird is the observation that homoeopathic medicines have clinical effects. In attempting to understand why these effects are seen, homoeopaths and respected scientists have embarked upon research into the clinical effects and into the physical properties of homoeopathic medicines.
Using the methods applicable to Western drugs, results of clinical trials are inconsistent. Homoeopaths therefore suggest that there may be other experimental methods which are more suitable. Research into the physical properties of the medicines has led workers into the field of quantum physics where some explanation of the observations can be found.
These two viewpoints are diametrically opposed and it is unlikely that they can be reconciled; they will certainly not be reconciled by a magician.
PETER GREGORY, BVSc, VetMFHom, MRCVS,
Snowflakes? And does Mr. Hoare seriously think that homoeopathy involves splitting the atom? Sheesh....
[Volume 33, no. 44, 17th November 2003, page 23.]
Study would enable a more sensible debate
How can Dr Kerr expect to understand the philosophy and theory of homoeopathy without making a proper study of it? If she bothered to attend one of the courses for veterinary surgeons that have been accredited by the Faculty of Homeopathy, she would have more knowledge of the subject and be in a position to debate it more sensibly.
The "Test" that she has proposed that I should undertake is completely unreasonable from a homoeopathic viewpoint and I regret that I must decline her invitation to participate in a circus act. If any of your readers would like me expand upon this they may contact me at Lyme Regis and we can discuss the matter rationally on an individual basis. I am, however, greatly concerned by her choice of language and obsession with illusion, deceit and shams, and by her apparent fixation upon monetary gain. There is no place for an illusionist in any laboratory that undertakes serious work. In fact, were one present then I would be more concerned for the location of my belt, braces, wallet and watch than I was for my work.
At the very beginning Dr Kerr stated, quite incorrectly, that there was no possibility that homoeopathic remedies at potencies above those that corresponded to a final dilution at or above 1x10-24 could affect mammalian physiology. There is no evidence that this statement is true. It is a mere opinion, or to put it more scientifically, an unproved hypothesis. She ruled almost 200 years of world-wide experience of provings, clinical records and RCTs as inadmissible because it did not conform to her archaic world view of Newtonian physics and Mendeleyev's chemistry. I do not deny that both these gentlemen made great advances in the science of their time, but they too have now been overtaken. Kleijnen took much the same view a few years ago as Dr Kerr does now, but at least he had the grace to admit that the evidence he had looked at showed that homoeopathy did work but he just could not get his mind to accept that conclusion.
The proof of the pudding is in the eating. The proof of homoeopathy is in the sucking. All good pharmacies and health food shops stock bottles of tablets that have been medicated with the 30cH potency of the most commonly used homoeopathic medicines.
All that anyone has to do to test (or prove) a homoeopathic medicine is to enter such a shop and purchase a bottle of such tablets. One tablet should then be sucked slowly twice a day. Most provers begin to exhibit symptoms associated with the medicine within three days; some take a little longer to begin to develop symptoms. Would-be provers should note that the tablets should be stored in a cool dry place, away from strong-smelling/highly scented substances, and not handled if at all possible. They are best administered by tipping a tablet from the bottle to the bottle cap, and from the cap into the mouth. It is also advisable to take the tablets at least 15 minutes before or after eating, cleaning one's teeth, or using a mouthwash.
If any reader wishes to try this simple experiment, but requires more detail of how to proceed, they may write to me at Lyme Regis. I would be pleased to learn of the experiences of anyone who does undertake this experiment. If I were to receive enough replies, favourable or unfavourable to my proposition, I could write a summary of the returns for your publication. Now, since the argument has come to an impasse, I will cease my contributions, unless someone writes a letter that is even more outrageous than that of Dr Kerr.
I would, however, like to see some answers to the questions that I posed in earlier letters, i.e. Is the opposition to homoeopathy based on a dislike of the underlying philosophy? Is the opposition based on the use of ultra-high Hahnemannian dilutions? If it is the latter, what dilutions are acceptable?
Why, if water is H2O, are no two snowflakes identical? Why is it that only animals that are going to make a spontaneous recovery from their disease visit homoeopaths, and why is it that conventional vets are only invited to treat animals that need conventional treatment?
I would also like answers to the following questions: If atoms are indivisible, how do cathode ray tubes work? Is Heisenberg's uncertainty principle of any value in measuring degrees of implausibility?
JOHN HOARE, BVSc, MRCVS, VetFHom,
Well, that's quite an alternative challenge. Write an even more outrageous letter! Hah, we dare you! Leaving aside the fact that we think Messrs. Gregory and Hoare have just about plumbed the depths of outrageousness, perhaps Mr. Taylor's response to the question of reference citation might qualify? His letter does an even more thorough deconstruction of Mr. Hoare's reference list than the summary we posted above, and we recommend a thorough perusal of his findings.
[Volume 33, no. 48, 15th December 2003, pages 22-23.]
What value references?
The problem with letters which are published followed by impressive lists of references is that it's actually quite difficult to track down and study references in detail. Most people will accept at face value the implication that the references do in fact support the claims being made in the letter. Thus anyone reading Mr Hoare's letter (6th October) would assume that the mainstream scientific studies quoted by him give unqualified support as to the effectiveness of homoeopathy.
From the tone of his letter Mr Hoare obviously feels that these trials represent the best evidence that homoeopathy is a valid medical modality. Previously I have suggested that these references are not as supportive of homoeopathy as Mr Hoare and others might hope but my hints have been ignored. Now I feel it is time to set the record straight by looking more closely at the papers in question.
The earliest meta-analysis quoted by Mr Hoare is that of Kleijnen et al. in the British Medical Journal in 1991.1 In fact this paper followed an earlier review (not mentioned by Mr Hoare) by Hill & Doyen in 1990,2 which found that most of the 40 homoeopathic trials looked at had major flaws and that overall there was no acceptable evidence that homoeopathic treatments are effective. The Kleijnen analysis quoted by Mr Hoare examined 107 trials and found that overall the quality of the trials was disappointing.
As a result their conclusion is hardly a ringing endorsement of homoeopathy: "At the moment the evidence of clinical trials is positive but not sufficient to draw definitive conclusions because most trials are of low methodological quality and because of the unknown role of publication bias. This indicates that there is a legitimate case for further evaluation of homoeopathy, but only by means of well performed trials."
The second meta-analysis quoted by Mr Hoare is that of Klaus Linde et al. in the Lancet in 1997.3 In this study 186 trials were located, 89 of which were included after those which failed to meet the correct criteria were eliminated. This review initially found positive evidence in favour of homoeopathy but again this is qualified by the statement: "There is insufficient evidence from these studies that any single type of homoeopathic treatment is clearly effective in any one clinical condition. The evidence in our overall analysis would be more compelling if there were independently replicated, large-scale rigorous trials of defined homoeopathic approaches in at least a few specific disorders. In addition, we cannot completely rule out bias as an explanation for these results."
In fact Linde's meta-analysis was revisited in the Journal of Clinical Epidemiology by Ernst and Pittler4 who re-analysed the data and stated: "Viewed in this way the reanalysis of Linde et al. can be seen as the ultimate epidemiological proof that homeopathic remedies are, in fact, placebos."
Linde himself, writing in the same journal in 1999,5 went on to say "We conclude that in the study set investigated, there was clear evidence that studies with better methodological quality tended to yield less positive results." As a further criticism of homoeopathic trials in general he states "in these trials homeopathy was mainly used for mild and chronic conditions for which there are few objective outcome measures."
Another reference mentioned in Mr Hoare's letter is the report to the European commission by Boissel et al. in 1996.6 In the European Journal of Clinical Pharmacology Boissel7 conducted a study which applied a statistical test to the results of 15 trials of homoeopathy. The most positive thing Boissel could find to say about these trials was: "In at least one trial, the experimental patients (i.e. those who were treated with homeopathic medicine) had some beneficial effects compared with the trial patients (i.e. those who received nothing, or a matching placebo), assuming that none of the pooled trials were biased in any way."
The authors make it clear, however, that they were unable to exclude such bias, and yet again their analysis disclosed that the better the quality of the trial the less positive the results became: "Sensitivity analysis showed that the P value tended towards a non-significant value (P = 0.08) as trials were excluded in a stepwise manner based on their level of quality.... There is some evidence that homeopathic treatments are more effective than placebo; however, the strength of this evidence is low because of the low methodological quality of the trials. Studies of high methodological quality were more likely to be negative than the lower quality studies. Further high quality studies are needed to confirm these results."
When the analysis was confined to the trials of the highest quality the statistical significance disappeared, thus confirming that bias was present. So once again, initially promising findings in favour of homoeopathy are qualified out of existence by bias and poor quality trials.
Since the analyses quoted by Mr Hoare, several major high quality trials (including 8 and 9) have returned negative results for homoeopathy. Again, Mr Hoare has omitted to mention these. In previous correspondence Mr Saxton has said we all rely on the references which best suit our position, so I must assume that the rather selective list Mr Hoare has produced (twice, now) is the best he can do. Plainly his best just isn't good enough, he is clutching at statistical straws.
It seems the only way that the chief proponents of homoeopathy in this debate are able to reassure themselves is to make ad hominem criticisms of anyone who doesn't share their views, in particular that anyone who disagrees with them simply hasn't studied the subject properly.
[The following paragraph was cut from the published version, presumably for reasons of length]
Incidentally, Mr Gregory is incorrect when he states (15th September issue) that science is unable to explain how bumble bees are able to fly. In fact biologist Michael Dickinson of the University of California, Berkeley, solved the problem some years ago and the principle is now very well understood.
The mechanism does not involve conventional aerodynamics but different concepts such as "delayed stall", "rigidity when flapping" and "rotational circulation"; terms I am sure our homoeopathic colleagues are very familiar with judging by their responses during this debate.
NIALL T. TAYLOR, BVM&S, MRCVS,
Before the next strictly homoeopathic contribution, there was another incident with related connotations. In the issue dated 26th January 2004 (vol. 34 no. 2 p. 16) a letter was published calling for the cessation of annual booster vaccinations. Of the 31 signatories, 24 just happened to be on the Register's list of 41 veterinary surgeons with homoeopathic qualifications - although they didn't happen to mention that in their signatures. The generally unexceptionable call to examine the evidence and give only those vaccines which are genuinely beneficial was marred by the pervasive suggestion that booster vaccines cause significant harm, something which simply cannot be substantiated. This letter spawned a lively thread of its own, but the other shoe didn't really drop until, appropriately, the first of April, the opening day of BSAVA Congress.
But meanwhile, back to February - now nearly a year after the start of all this - and the homoeopathy thread itself.
[Volume 34, no. 3, 2nd February 2004, page 22.]
Homoeopathy: no sympathy for magicians
Mr Gregory tells us that homoeopathy (invented in Germany) gives inconsistent results in clinical trials conducted by "Western" methods (17th November). That in itself should surely ring some warning bells. Mr. Hoare, however, suggests a simple test. Just take a few homoeopathically medicated tablets and wait to be amazed by the unmistakable symptoms which will result.
My own suggested protocol was to my mind strikingly similar. Just take a few tablets, either homoeopathically medicated or unmedicated (not knowing which), then state which they were by observing whether or not any symptoms do in fact result. It's a pity both gentlemen have declared their withdrawal from the correspondence, otherwise one of them might have been able to explain why the first test is acceptable while the second is "completely unreasonable from a homoeopathic viewpoint". Can anyone else offer any suggestions?
However, this isn't about persuading either Mr. Gregory or Mr. Hoare to consider whether they might possibly be mistaken [- that is obviously an impossible task]. The real question we must all face as professionals is, should we continue to accord their practices diplomatic immunity from complying with the requirements of evidence-based medicine?
The plural of anecdote is not data, and we all know very well how easy it is to persuade ourselves that a useless intervention has in fact had a beneficial effect on a patient - homoeopathy has no monopoly on that! It is for this reason that we must require more than the uncontrolled observations of patients and doctors to validate any therapy.
Homoeopathy is currently in a very embarrassing position. In spite of two or three early meta-analyses which appeared to provide some weak support for the method, largely by ignoring the variable quality of the trials included, subsequent re-analyses of the data and results from larger, better-controlled trials have tended inexorably to the conclusion of null-effect, as Mr. Taylor has explained. Hence Mr. Gregory's admission.
Homoeopathy has now turned elsewhere in an attempt to retain some semblance of credibility. As I outlined in an earlier letter, the latest proposal is to explain the discrepancy between the clinical anecdotes and the well-controlled trials by invoking an effect of the intent or under standing of the practitioner. It is not sufficient just to turn on this light switch, one has to know that the light is supposed to come on and intend that it should come on. The latest ploy is to dress this up as some sort of 'quantum' effect, and indeed the entirely self-referencing concept of 'weak quantum theory' (Atmanspacher et al., 2002) seems to have been invented by a group of homoeopaths to support this viewpoint. This may give them something to talk about during the long winter evenings, but a theory which summarily ditches Planck's constant (one of the three fundamental universal constants of nature, which appears in many important equations of quantum mechanics) probably doesn't have much of a future in real science.
For a striking example of magical thinking in modern homoeopathic practice, the web site of the Homoeopathic Information Service (attached to the School of Homoeopathy in Devon) is hard to beat (www.hominf.org/proving.htm). This site was offered to me as the best example of the rigorous, double-blind, placebo-controlled proving methods we're assured are standard practice in the 21st century. The depth of the New-Age mysticism there revealed is difficult to convey in a few words, but it is unmistakably classic Frazerian sympathetic magic.
Now it has to be admitted that this group are lay people, not medically qualified. It is presumably to protect animal patients from such fruitcakes that our homoeopathic colleagues so strenuously defend the inclusion of homoeopathy within veterinary practice. However, the closer one investigates the subject, the more difficult it is to draw any distinction between the practices of the lay magicians and the medical quantum mechanics. Indeed, if in the final analysis one is going to treat an animal with a content-free 'medicine', does it matter whether or not it is a vet who prescribes it? Let us not confuse this with 'off data sheet' prescribing. This has nothing to do with the use of things like azathioprine or fludrocortisone or carbimazole or even copper sulphate. This is about making therapeutic claims for nothing at all.
The unstated implication seems to be that a vet can surely be trusted to discern when a patient really does need effective medication (or surgery) and restrict the homoeopathy either to self-limiting conditions or to situations where no effective treatment is available. However, given the statements we have all read about 'allopaths' being mistaken (funny, I don't remember studying anything called 'allopathy'), and colleagues who seldom if ever resort to 'allopathic' methods, can we really rely on this to happen? The web site of the British Association of Homoeopathic Veterinary Surgeons (www.bahvs.com/history.html) includes a wholly fallacious theory of 'chronic disease', coupled with the astonishing statement that 'orthodox' treatment "will drive the disease inward, possibly to be later expressed as allergy, asthma, epilepsy, cancer etc." This is indeed scary stuff.
Animal welfare would surely much better served if those who are guilty of neglecting their charges by non-treatment of illness are not able to represent to the Bench that an accepted form of veterinary medicine has been applied to the patient. In addition, with governments of all political hues now looking much more closely at the privileged status of the professions, it is only by a demonstrable commitment to high standards of evidence-based medicine and rigorous scientific practice that we will continue to be regarded as trustworthy to regulate ourselves. If we descend to the level of simply selling anything the public seems to want to buy, we will undoubtedly pay a heavy price in the longer term.
The 2003 edition of the RCVS Register, which incidentally now includes a statement that homoeopathic qualifications are not accredited by the RCVS, lists a mere 41 names in that category. The BAHVS web site claims 140 members. This out of a total of over 20,000 members of the RCVS as a whole. Perhaps a few more of the >99% of the profession who are not practising Sympathetic Magic might like to chip in with their views on this?
MORAG KERR, BVMS, BSc, PhD, CBiol, FIBiol, MRCVS,
ATMANSPACHER, H., RÖMER, H. & WALACH, H. (2002) Weak Quantum Theory: Complementarity and entanglement in physics and beyond. Foundations of Physics 32, 379-406.
Immediately following this letter was another mostly incomprehensible offering from a homoeopath. This seems mainly to be yet another assertion that homoeopathy cannot be judged by conventional standards, because the only purpose is to discover the correct remedy for the individual patient. It's interesting to note that the author admits that he regularly fails in his practice of homoeopathy, nevertheless he remains convinced of its efficacy.
[Volume 34, no. 3, 2nd February 2004, page 22.]
Not comparable to conventional medicine
In response to the sometimes heavy-handed exchanges on the subject of homoeopathy over the last few months, I'd like to make the following comments.
Most trials that "confirmed" or failed to confirm the efficiency of homoeopathy did not teach us anything about the efficacy of homoeopathy at all. The only thing that they may have measured (or not measured) is whether the presence of a homoeopathically diluted remedy in a trial made a difference in the outcome of the trial or not. In other words: whether homoeopathically diluted substances have an effect on the human or animal body, whether they have a reality or not. (Please check the references on this matter at the end of this letter for yourself.)
Homoeopathy does not compare to conventional medicine in any way whatsoever and is therefore unlikely to be proven by conventional standards.
The only purpose of the homoeopathic prescription technique is to find the remedy for each individual patient to which he/she is particularly sensitive and which will cause a change in his/her sensitivity that will result in the disappearance or improvement of some or many of his/her sufferings (disease, symptoms, behaviour, etc.). Homoeopathy is about idiosyncrasy, to use a modern terminology.
All attempts made over the years to incorporate some modern science into homoeopathy never produced any help in improving homoeopathic prescription.
I can assure you that its practice is not an easy task and that I (and others) regularly fail. I was (and am) taught to consider a prescription to be homoeopathic and efficient if an animal becomes free from his main complaint and most of his troubles, more rapidly, for a longer time and without the reappearance of any other disease than what can be expected through natural evolution and/or conventional treatments, without the help of any other measures and without the need for repeated administration of the homoeopathic remedy.
On a regular basis I obtain such results, enough to keep me motivated to pursue. Luckily, there are many clients you cannot fool with your results, but I also have clients who think that I have done wonders, but I know for myself that I have not made a big difference in the outcome of the health of their pet. It is up to my integrity not to abuse the confidence of the client and also to recognise a polite client from somebody who really noticed a difference after homoeopathic prescription. That is part of reality.
One of the problems with homoeopathy is in defining its borders with herbal medicine, conventional medicine and other techniques like isotherapy and oligotherapy.
The way homoeopathy collects its information has given rise to the appearance of "renowned activity" for many substances. (Modern medicine has made use of such information and incorporated medicines in its pharmacopoeia after scientific testing when their "renowned activity" came to the attention of an interested researcher.) Many homoeopathic medicines are used for their "renowned activity": this may sometimes (or often?) be helpful to patients but does not reflect the essence of homoeopathy.
Modern scientific medicine has its advantages and inconveniences, homoeopathy has its advantages and inconveniences. Stop arguing and start exchanging ideas.
Homoeopathy has been around too long and is (has been) practised by too many people (mainly educated in conventional medicine!) to be eliminated from the scene. We can work together to improve results for the patients as long as we accept and respect that both techniques function on very different concepts.
Not everybody will make a perfect homoeopath, not everybody will make a perfect conventional vet. We all have different affinities and, therefore, different opinions. Variation is the main reason why nature has been so successful.
Awaiting the stirring....
EDWARD DE BEUKELAER, MRCVS,
On the interest from physics in high-diluted remedies, check the following references for yourself:
Yes, we should "exchange ideas". But let scientific medicine dare to suggest the idea of objective confirmation for the claim that "an animal becomes free from his main complaint and most of his troubles, more rapidly, for a longer time and without the reappearance of any other disease than what can be expected through natural evolution and/or conventional treatments", and any pretence of working together will soon end!
It's interesting that Mr. de Baekelaer doesn't just claim an absolute effect for homoeopathy, but an effect greater than that of conventional treatment. Since so many conventional treatments have such dramatic and self-evident effects, you'd think it would be an easy claim to substantiate, wouldn't you? However, once again homoeopathy has to be judged by different standards. In fact it seems to be a regular feature of homoeopathic conversation that differences of opinion are welcomed and accepted as valid, varied viewpoints - for all the world as if we were discussing whether Jane Austen or Charlotte Brontë is the better author. The concepts of absolute verifiable truth and the systematic discovery of such truth through objective experimentation seem to be completely foreign to their way of thinking.
Reproducing all the argument generated by the anti-vaccination letter would be something of a red herring, but within a couple of weeks the inevitable connection had been made with the unstated homoeopathic predilections of the majority of the authors.
[Volume 34, no. 5, 16th February 2004, page 27.]
A self-interest group?
I am interested to note that of the 31 signatories calling for the cessation of annual vaccination for dogs and cats, 24 of them are in the RCVS register as homoeopathic veterinarians, a fact which is not mentioned in their letter.
I may not have my facts totally correct, but, as I understand it, homoeopathy does not agree with "normal" vaccination policies, much as it feels about "normal" veterinary medicine. I detect the scent of a self-interest group, but would not dream about drawing any conclusions.
E. J. A. MACHOLC, BVSc, MRCVS,
[Volume 34, no. 5, 16th February 2004, page 27.]
I was pleased to see a number of colleagues, in suggesting a review of appropriate vaccination programmes, come out in support of the benefits and safety of a well-thought-out vaccination [policy] (26th January issue).
Sadly, their homoeopathic "qualifications" seem to have been omitted from their signatures. Unaccountably, Mark Elliott's VetMFHom recovered from its bout of shyness to feature in the signature of the letter published on his own name in the same issue. Shurely shome mishtake?
I look forward to the homoeopaths' enthusiasm for evidence-based medicine extending to the claimed benefits of magic water. I particularly look forward to a review, based on high-quality data, of strategies using nosodes rather than licensed vaccines for the prevention of disease.
SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
Regrettably, the anti-vaccinators' response has concentrated mainly on deploring the highlighting of the 24 homoeopathic qualifications among the 31 signatories, rather than on addressing the very relevant points made concerning the lack of evidence of harm from booster vaccines (indeed the emerging positive evidence of lack of harm), and the consequent desirability of awaiting a variation in the terms of the appropriate product licences rather than attempting a unilateral and unsupported rewriting of vaccination protocols.
However, the next contribution returned to purely homoeopathic matters, representing the third try at persuading the homoeopaths to put their mouths where their money is and demonstrate that they can indeed recognise proving effects. Although they seem to be so unworldly that even the suggestion that they might win a million dollars by doing this causes them to recoil in distaste, perhaps Mr. Taylor's low-key and anonymous version will attract more takers....
[Volume 34, no. 6, 23rd February 2004, page 22.]
Invitation to prove one way or the other
Having considered the recent debate concerning homoeopathy, I still have reservations. On the one hand we have the argument of scientific implausibility and poor performance in trials, and on the other we have the argument that in the clinical situation many feel that there is benefit to be had from homoeopathy.
While my feelings are that the scientific evidence is poor or lacking, I am a true sceptic, meaning I have an open mind and am prepared to accept the evidence in a disinterested way.
In an attempt to satisfy my curiosity as to whether or not there really is something out there, I intend to carry out a modest clinial trial. The main ideas behind this have come from contribuors to the Veterinary Times debate, namely Mr Hoare and Dr Kerr.
I have come up with some procedures for running it in a way that I hope is unbiased, anonymous and non-confrontational and will give objective results that require no interpretation. To improve compliance and accuracy, the input required by participants will be simple and straightforward. Results from all participants will be treated in strictest confidence, and no one other than myself will know the names of those taking part (although individuals involved in the trial will be given the opportunity to know their own results).
The aim of the trial is to discover whether it is possible to distinguish between a homoeopathic remedy and a placebo preparation by any method that the participant may prefer, including, but not limited to, a homoeopathic proving.
This type of test using a proving was first mooted by Mr Hoare in his letter to Veterinary Times (23rd June 2003) and again on 17th November when he stated that "the proof of homoeopathy is in the sucking" and, later, "all anyone has to do to test (prove) a homoeopathic medicine is to enter a shop and purchase a bottle of such tablets".
He goes on to say that most provers, including sceptics, will begin to show symptoms within three days of taking the tablets; this leads me to believe that those with experience in such areas will have no trouble making the correct distinction, thus making his a trial involving believers (as favoured by Mr Hoare) rather han non-believers (as favoured by Dr Kerr).
Nowhere in Mr Hoare's correspondence or in Hahnemann's Organon is it suggested that provers need to be individualised for a particular remedy in the same way that patients do when undergoing homoeopathic treatment, since plainly it would be impossible to individualise a remedy prior to its characteristics being known.
This is, therefore, the perfect test for homoeopathy with none of the pitfalls of the clinical setting where observations can be subjective and patients unpredictable, and poor results are often attributed to problems with individualisation.
A homoeopathic proving by an individual or group has the virtue of being a well-recognised homoeopathic technique, but in fact any technique would be allowed. Methods used in previous, similar studies have included clinical trials on volunteers, dowsing, radionics, crystallographic analysis and spectographic anlaysis.
By default, the trial will use 30C Belladonna, although participants will be given the opportunity to select any remedy they may prefer or feel is more appropriate for whatever reason. Each participant will be randomly allocated either the test substance or a placebo, which will be sent to them by post.
I would be grateful for any information Mr Hoare or others could supply in addition to that already described in previous letters that would give the greatest likelihood of determining remedy from placebo.
I would like to ask anyone interested in participating in the trial, either as a volunteer or with advice, to please contact me by letter at Orchard Veterinary Group, or by e-mail on firstname.lastname@example.org. For reasons of economy I have to limit participants to the UK at this stage. I will shortly be contacting potential participants, individually inviting them to take part in the trial and giving a brief outline of the protocol. I will also be sending letters similar to this one to other journals.
NIALL T. TAYLOR, BVM&S, MRCVS,
There hasn't been an published update on this trial at the time of writing this (September 2004), but we hear that the response has been very sparse. Never mind, we also hear that no less than 50% of the participants have successfully distinguished whether they received remedy or placebo. No doubt this result, should it be substantiated, will be hailed by the homoeopathic community as resounding proof of the efficacy of their methods - that would be entirely in keeping with their usual interpretation of statistics.
A couple of weeks later it became clear that the homoeopaths were crying "uncle" - or crying to uncle, at any rate!
[Volume 34, no. 9, 15th March 2004, page 38.]
Homoeopathy well integrated into NHS
I am the current president of the Faculty of Homoeopathy and, as such, I have been shown the recent exchanges about homoeopathy in Veterinary Times by some of the Faculty's veterinary members. It makes for rather sad reading. It's a shame that those who espouse the cause of rigorous science sink to the level of personal insult and abuse.
Why become a vet? Has it something to do with the desire to relieve the suffering of animals? If so, what happens when you reflect on your daily practice? How successfully do you relieve the suffering of animals? How do you know? What are you measuring? Animals aren't machines with broken or faulty parts to be fixed or replaced. They are organisms and they are alive. For many years, medical sciences (and I include veterinary medicine here) have been studied and practised using a mechanistic paradigm. However, in recent years, scientists have developed a more satisfactory model of life. I refer to that of the "complex adaptive system".1
Such a "system" has certain characteristics. These include the facts that they are complex, but built from simple rules; they have the capacity to adapt to changes in their internal and external environments; they can produce novel behaviours and are unpredictable at a detailed level. There are many other characteristics. Does this matter? It does because this helps us tounderstand the science of life, of health and of disease.
Meta-analyses and randomised controlled trials don't give us "truth", they only give us the results of experiments which might be useful for us to consider when we try to relieve the suffering of an animal we have to treat today. As Professor Sackett made clear in his innovative description of "evidence-based medicine",2 these studies are only one aspect to consider in the treatment of an individual. In a clinical situation, many other factors must be considered and choices must be taken. It would lead to very inappropriate and ineffective care were we all to blindly apply the conclusions of meta-analyses in an unthinking way.
As a medical doctor, I do hope to relieve the suffering of the individual patients who present to me each day. Trying to understand how well I achieve that goal is not a simple matter of measuring a particular biological parameter, or comparing my treatment choices with the results of experiments. It's simplistic to think otherwise.
Veterinary medicine is, I believe, a caring practice. The vets I meet at Faculty of Homoeopathy events are certainly passionate about their work, passionate about the animals they treat and passionate about their attempts to relieve suffering.
If I ever have to seek the help of a vet, I hope I can find one who meets those high standards because if a vet really is passionate about his or her work then he or she will be a reflective practitioner who considers carefully his or her daily practice, is aware of the conclusions of randomised controlled trials, and offers the best therapeutic interventions he or she can to relieve the suffering of the patients. On top of that, the vet will actually treat the animal with care and with a conscious choice to use treatments which don't cause unnecessary harm.
Homoeopathy has always been an integral, accepted part of the National Health Service. When the NHS was created it included the five homoeopathic hospitals. Around the same time an Act of Parliament created the Faculty of Homoeopathy to set the standards of training in homoeopathy for healthcare professionals. The Faculty has around 1,300 members and is routinely consulted by the GMC and the medico-legal defence organisations for au thoritative advice in relation to the use of homoeopathy by doctors. The NHS homoeopathic hospitals mainly treat patients whose suffering has failed to be relieved by the best evidence-based treatments. An average of 70 per cent of them claim their symptoms are relieved to the point where their lives are significantly better after their homoeopathic treatment. This highlights two important points: what do we offer those who aren't helped sufficiently by the best "evidence-based" techniques? And, why deny 70 per cent of those patients the relief they seek?
It is misguided to think of homoeopathy as something "New Age" or "alternative". It's been around for 200 years and in the UK an NHS doctOr can prescribe any homoeopathic medicine on a standard prescription form which the patient can cake to any NHS pharmacy. Around 25 per cent of Scotland's GPs have personally taken some training in homoeopathy and 100 per cent of all GP practices in the NHS Glasgow area have refereed patients for treatment at Glasgow Homoeopathic Hospital. Homoeopathy is well established and well integrated into the National Health Service - it always has been.
Why should animals be excluded from receiving the potential benefits of this treatment?
Good veterinary practice is not just about the selection of drugs and good surgical technique. It's about people too (vets): people who have certain qualities, values and attitudes. Finally, it's about animals. Each animal is unique and deserves to be cared for by vets who care about them.
So, before passing judgement on your colleagues on the basis of certain theories, why not consider all veterinary practice on the basis of how well it meets the needs of its patients by relieving their suffering? This, of course, is not as easy to do as simple laboratory measurements, but it's what matters to our patients and it's what should matter to us.
R. W. LECKRIDGE, MB, ChB, FFHom,
Sigh. Why do so many homoeopaths seem to be unable to read any reasoned criticism without crying "insult!"?
It's a matter of record that the homoeopathic hospitals were 'grandfathered' into the NHS when it was set up in the late 1940s, thanks in great measure to the extensive political clout wielded by the homoeopathic fraternity, including the support of the royal family, who remain convinced believers to this day. What this has to do with efficacy is anyone's guess.
This letter is in fact a partisan proposal of the case for the legitimate use of placebo. Never mind the evidence (even though a treatise on evidence-based medicine gets a name-check), take an opinion poll! It may be interesting that 70% of people who were listened to sympthetically and given a content-free 'drug' either thought they had improved at least a little bit, or were too polite to admit they hadn't, but it is completely irrelevant to the question of efficacy. Even assuming Dr. Leckridge's statistics are correct, there is no mention of how many general practitioners referring to homoeopaths have any belief in homoeopathy, as opposed to being quite relieved that a difficult patient has asked for a referral which will get them out of the way.
The question of the ethical use of placebo in human medicine is a difficult one. Technically, it is verboten, but if it can realistically improve the perceived condition of even a proportion of patients, should it be? However, this is a question for our medical colleagues. Although a 'placebo' effect is easy to demonstrate in veterinary medicine too, this is virtually always attributable to an effect on the perceptions of the owner or other person judging the animal's condition. It is very hard to justify administering placebo to animals simply to make their owners feel better.
Therefore, Dr. Leckridge's arguments simply beg the question. Is there any actual demonstrable efficacy in homoeopathic preparations? If not, then no amount of human patients tricked into a feeling of well-being can possibly justify their use on animals patients.
What's so hard about this? Homoeopathy claims that its remedies have an actual physiological effect on the body. If so, it should be possible to demonstrate this to the satisfaction of any disinterested observer. But no, all we get are evasions and obfuscations.
As Mr. Taylor duly noted.
[Volume 34, no. 11, 29th March 2004, page 35.]
No substitute for proper evidence
In the light of the publication of yet another article which finds evidence that homoeopathy is ineffective1 and when even homoeopaths themselves admit there is no discernible difference between a remedy and a placebo,2 Dr Leckridge (l5th March issue) should realise that talk of "complex adaptive systems" is no substitute for proper evidence. Like similar spurious claims for quantum mechanics, radionics and vibrational medicine, such remarks are simply plausible-sounding smokescreens which attempt to disguise the fact that all available, good quality, evidence points to the conclusion that homoeopathy has no place in proper medicine.
Like the veterinary homoeopaths that Dr Leckridge has met, I too am a caring vet, I am passionate about my work, the animals I treat and my attempts to relieve suffering; I know that animals are unique and deserve to be "cared for by vets who care about them". I also have an open mind about the evidence and it is for those self-same reasons that I cannot condone the use of homoeopathy.
Finally, I have never insulted or abused anyone in these columns and I am upset when such accusations are used to further cloud the issue and discredit reasonable arguments. To quote a remark I overheard in the school playground recently from an exasperated mother admonishing her temperamental child, "Just because I don't agree with you doesn't mean I'm not being fair."
NIALL T. TAYLOR, BVM&S, MRCVS,
After that, the homoeopathy discussion went quite for a little while, as the bulk the correspondents' ire directed itself to the question of the case for the annual booster vaccination. This discussion became significantly more heated after 1st April, the opening day of the BSAVA Congress, and the day on which Mr. Saxton was interviewed on the Today programme denouncing booster vaccinations as fraud and vets who administered them as fraudsters. This somewhat overshadowed the publication on the same day of a large-scale, carefully randomised study by workers at the Animal Health Trust which completely failed to find any increase in the incidence of any ailments whatsoever in the weeks or months following such boosters. Never mind, though, as Chris Day (another VetFFHom) explained a week or so later on Radio Scotland, such studies count for nothing in the light of what he believes he sees in his consulting room. This argument continued for quite some time.
However, on 17th May, the journal finally published an article on homoeopathy submitted by Mr. Taylor several months earlier. Unnecessary Pseudoscience. Apparently the editor was waiting until he received a pro-homoeopathy article he could balance it with. Protestations that this was intended to balance all the uncontested pro-homoeopathy propaganda published in the past fell on deaf ears.
Nevertheless, before any feedback was received to that article, the vaccination debate spilled over into the homoeopathy debate for the second time. It seems that the ever-more-strident accusations of malpractice being made against the lawabiding vets by the homoeopaths and their supporters had become too much for a couple of people to ignore.
[Volume 34, no. 20, 31st May 2004, page 23.]
The issue of fraud....
The word "fraud" has been bandied around rather freely in these pages and elsewhere, in relation to the use by veterinary surgeons of canine vaccines, entirely within the terms of the relevant data sheets, and fully compliant with the Medicines Act.
If we consider the original source of these allegations, is it not reasonable also to raise the question of claims by veterinary surgeons that diseases are caused by disturbances of a mysterious (and undetectable) "vital force", the treatment of these disturbances by unlicensed medicines without a single molecule of active ingredient, and clients being charged for "veterinary" services consisting of such unscientific diagnoses and even more unscientific therapies?
To whom might the term "fraud" be more reasonably applied?
MORAG KERR, BVMS, BSc, PhD, CBiol, FIBiol, MRCVS,
[Volume 34, no. 21, 7th June 2004, page 34.]
Response 'a bit rich'
It really is a bit rich of Messrs Saxton, Allport et al. (24th May issue) to respond with startled innocence when their homoeopathic qualifications are queried in the context of their advice on vaccination.
Reasonable practitioners (despite being called fraud and thief) have always reviewed and modified vaccination policies based on proper advice. The reason for any incredulity is the expectation that we should now take this advice from people who believe in crystal healing, radionics and sending homoeopathic remedies by e-mail.
And the promised "balancing article" eventually made its appearance on 28th June. Why such antipathy to homoeopathy?
This article provoked considerable resopnse, and we were off again!
[Volume 34, no. 26, 12th July 2004, page 24.]
Homoeopathy: 'it's a funny old world'
I read with interest Peter Gregory's apologia for homoeopathy (28th June issue). He said, "The only feasible way to explain this dramatic recovery (of the first case in which he used homoeopathy) was that the homoeopathic medicine had acted beneficially." The fact he could find only one feasible explanation is, surely, at the heart of the problem.
On this letters page I have previously mentioned cases in which failure to respond to treatment was claimed as success. If, in addition, all cases that improve are also ascribed only to the power of homoeopathy then that completes the set.
The Looking Glass world of homoeopathy is full of startling anecdotes. What it is not full of is replicable success under controlled conditions when all parties are blinded to the nature of the treatments. As Morag Kerr has pointed out more than once, dramatic tales of complete cure shuffle off into the margins of statistical noise once the biased observers are eliminated.
I have my own stories of chronically sick patlents who inconveniently got suddenly permanently better while I was in the process of getting their medication worked out. I have no problem accepting coincidences. It's a funny old world.
SIMON J. BAKER, MA, VetMB, PhD, MRCVS,
[Volume 34, no. 26, 12th July 2004, page 24.]
One day we will discover how it works....
'May I compliment Peter Gregory on his article in the 28th June issue? I have been using homoeopathy alongside orthodox medicine and surgery for over 20 years. Like Peter I came upon alternative medicine by using, in my case, acupuncture on an incurable patient. Having discovered acupuncture I then went on to train in homoeopathy. I had equally good results in homoeopathy as I did with acupuncture.
Most of the cases I take on are unable to be treated in the ordinary manner and at least 80 per cent improve. Now, 30 years after qualifying as a veterinary surgeon and after four years hard study (yes, it takes nearly as long to train as a homoeopath as it does to be a vet), I have just qualified as a professional homoeopath and am now qualified to treat my patients' owners too.
Why would I do that if I was not impressed by the results homoeopathy gives me? Homoeopathy is not a cure-all and in animals: is more difficult as we do not really know what is going on in their mind, only what we can gain by observation and what the owner tells us. In classical homoeopathy the patient's feelings are very important for us to select the right remedy. In animals, therefore, homoeopathy is often done on a therapeutic basis with as much of the emotional make-up of the animal as we can determine. Even so we can get excellent results. In humans you can say it is psychosomatic but in animals you cannot.
Arguments against homoeopathy are based purely on ignorance but perhaps homoeopaths are to blame for this as homoeopathy is very complex subject and sometimes difficult to explain. One ay, hopefully in the not too distant future, we will discover how the immune system is stimulated by homoeopathy and acupuncture. It will be from the same source I am sure in the realms of quantum physics.
Meantime, let us take a look at an old Chinese proverb: "The mind is like a parachute, it only works when open." I keep a very open mind and am still learning 30 years on.
TRIXIE WILLIAMS, BVSc, MRCVS,
Oh no, not "quantum" again! It looks as if repeated entanglement with the untenable has finally pushed Mr. Taylor somewhere beyond the reach of the Newtonian paradigm....
[Volume 34, no. 26, 12th July 2004, page 24.]
Towards a new dawn of enlightenment....
I would like to congratulate Peter Gregory on his excellent article on homoeopathy (28th June issue). I am flattered that he has mirrored the style of my original article and even seen fit to quote me. As a fellow alternative practitioner I completely share his views of course and am envious that he has provided a much more elegant illustration of why double-blind trials are useless for the investigation of our chosen modalities yet it is quite appropriate to accept the results of trials that support our views - something the Newtonian mind will never grasp.
Sadly I feel that it may never be possible for there to be a meeting of minds between alternative practitioners and the few sceptics in the profession. It is my firm belief that the future for Peter and me is in a rapprochement between what are after all merely two parts of the same whole, namely homoeopathy and veterinary voodoo. I know we have had our disagreements in the past but it is time to let bygones be bygones.
Yes (and I'm sure Peter won't mind me saying this) voodoo has a longer history than homoeopathy and tends to exert a more powerful effect on patients (this may explain the greater number of our followers!) but there are meny similatiries to celebrate. Like Peter, I have excellent case results, which can only be explained by the effectiveness of voodoo. I have great success with FLUTD in cats, only recently saving one patient the trauma of long-term medication and catheterisation by careful application of the correct Loa (or spirit). I achieve spectacular results in the type of pelvic injury described in Peter's article and I have even corrected a bovine dystocia from a distance of two miles by manipulating a poppet (or doll).
Like homoeopathy, voodoo is close to producing evidence for mode of action. It is strongly believed that deterministic quantum teleportation of atomic qubits using a semi-conductor nano-crystal energy transfer pump powering a symmetrically arrayed electron hole in the quantum dot carbon nanotube1 will prove to be the final piece of the jigsaw for us.
Let me say in closing that I look forward to the day when voodoo hungans (or priests) and homoeopaths march arm in arm together to greet a new dawn of enlightenment for all and I thank Peter for making the first move.
"If you can't beat 'em, join 'em." - Freddie Mercury
NIALL T. TAYLOR, BVM&S, VetFFVoo, MRCVS,
This next letter must be about the third time of trying to get the homoeopaths to claim the million dollars. You'd think given the number of them that there might be at least one who would like a bit more spare cash....
[Volume 34, no. 27, 19th July 2004, page 35.]
Money is there for the taking
Mr Gregory (28th June issue) tells us that "recent research claims to have identified the receptor sites upon which homoeopathic medicines act". As he did not actually bother to read this "research" before promoting its astounding findings in your pages, could he perhaps be persuaded to cite the relevant references so that those of us who are slightly less credulous of such claims might review the evidence for ourselves?
If true, this would of course be an immense boost to the credibility of his discipline. Attempts to enlist quantum physics theories to aid the search for the elusive "mechanism of action" are of course futile, as there is no possible way quantum theory can be applied to homoeopathy, and even those homoeopaths publishing on the subject admit that they are only employing a metaphor. Real, demonstrable receptor sites would therefore be an enormous advance.
Permit me, however, to remain sceptical a little longer. However much despised by the homoeopathic community, the JREF Million Dollar Challenge is still available to anyone who can distinguish a homoeopathically-prepared remedy from a chemically identical sham, in any way at all. Affecting a receptor site would of course be a suitable test protocol (as would really managing to cure patients on a repeatable basis, recognising "proving" effects, demonstrating these elusive crystal structures of water, or even dowsing as practised by the radionics enthusiasts). I wonder if the authors of the publications Mr. Gregory has failed to cite are aware of the fortune which should be theirs for the taking?
MORAG G. KERR, BVMS, BSc, PhD, CBiol, FIBiol, MRCVS,
Mr. Plenderleith's latest contribution might be more easily understood by reminding readers that Prince Charles had just come out in support of an "alternative" practitioner who claimed to be able to cure cancer by means of coffee enemas (yes, really!).
[Volume 34, no. 29, 2nd August 2004, page 26.]
What goes round, comes round....
The supporters of "A drop in the ocean" holistic approach must have been much buoyed by the recent support of Prince Charles. With friends like that, who needs enemies (mine's coffee, black with two sweeteners)?
In Claire Tomalin's excellent book, Samuel Pepys - The Unequalled Self, she refers to a certain Dr Goddard, Cromwell's chief physician, who made "Goddard's drops" which contained, among other things, spirit of Harts horn, crushed human bones and vipers' flesh (at least they contained something!) and were deemed good for lethargies, fainting, etc.
The good Dr Goddard (introduced to Pepys in 1665 at the Royal Society) must have feared for his future on the death of Cromwell and the resultant restoration.
He need not have been worried as he now had a ready new customer - King Charles II!
As they say in Lincolnshire, "Eeh lad, what goes round, comes round."
ROBERT W. PLENDERLEITH, BVMS, MRCVS,
The following week, in addition to Mr. Gregory going on the defensive, an apparently unrelated letter was published which has the potential to change the ground rules on this debate quite significantly. Please turn over....
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